Figure 5

Peritoneal cancer index (PCI). Two transverse planes and two sagittal planes divide the abdomen into 9 regions. The upper transverse plane is located at the lowest aspect of the costal margin and the lower transverse plane is placed at the anterior superior iliac spine. The sagittal planes divide the abdomen into three equal sectors. The lines define the nine regions which are numbered in a clockwise direction with 0 at the umbilicus and 1 defining the space beneath the right hemidiaphragm. Regions 9–12 divide the small bowel. Lesion size score is determined after complete lysis of all adhesions and the complete inspection of all parietal and visceral peritoneal surfaces. It refers to the greatest diameter of tumor implants that are distributed on the peritoneal surfaces. Primary tumors or localized recurrences at the primary site that can be removed definitively are excluded from the lesion size assessment. If there is confluence of disease matting abdominal or pelvic structures together, this is automatically scored as L-3 even if it is a thin confluence of cancerous implants.