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Table 1 Review areas for unfavourable sites [44] (published with permission from clinical radiology)

From: Communicating imaging findings in peritoneal mesothelioma: the impact of ‘PAUSE’ on surgical decision-making

U1* sites

U2** sites

Disease in the epigastric region

Biliary obstruction due to tumour

Lesser omentum/lesser sac/around the left lobe of liver/fissures/falciform ligament/ligamentum teres/encasement of left gastric artery

 

Porta hepatis/porto-caval space/gallbladder fossa/near hepatic vein or IVC

Coeliac, periportal, epiphrenic and retroperitoneal nodes

Spleen

 

Stomach encasement

Root of mesentery/ligament of treitz

Peri-pancreatic and para-duodenal space

 

Disease in the retroperitoneum

DJ flexure, most of the proximal small bowel involved, small bowel obstruction, stellate mesentery

Hydronephrosis and ureteric involvement

 

Psoas, iliacus and quadratus lumborum muscles

 

Pelvis

Pelvic side wall disease/nodes

Bladder trigone

 

Seminal vesicle, prostate

 

Disease encasing the external iliac vessels

Disease involving the sacrum

  1. *U1 sites increase surgical complexity and may need, for example, gastrectomy, Whipple’s procedure, nephrectomy, ureteric reimplantation, cystectomy or prostatectomy
  2. **U2 sites reduce the likelihood of complete cytoreduction