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Page 6 of 16 Sugarbaker. J Cancer Metastasis Treat 2018;4:7 I http://dx.doi.org/10.20517/2394-4722.2017.67

1.0
Completeness of cytoreduction
0.9
0.8 0 mm
< 2.5 mm
0.7 ≥ 2.5 mm
Survival probability 0.5
0.6

0.4
0.3
0.2
0.1

0.0
0 1 2 3 4 5
Years

Figure 3. Overall survival of 159 patients treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy according to
completeness of cytoreductive surgery. (From Glehen et al. [33] with permission)

1.0
Peritoneal cancer index
0.9
0-6
0.8
7-12
0.7
13-19
Survival probability 0.5
0.6
> 19
0.4
0.3

0.2
0.1
0.0
0 1 2 3 4 5
Years

Figure 4. Overall survival of 159 patients treated by complete cytoreductive surgery according to extent of peritoneal metastases
assessed by the peritoneal cancer index. (From Glehen et al. [33] with permission)

after CRS died as compared to 85.3% (29 of 34) of CRS with HIPEC patients who died. Median survival
was 6.5 months (95% CI 4.8-8.2 months) after CRS as compared to 11 months (95% CI 10.0-11.9 months)
in CRS with HIPEC group (P = 0.046). There was similar morbidity between the groups. The independent
predictors in a multivariate analysis for improved survival were synchronous peritoneal metastases, CC
0-1 cytoreduction, more than 6 cycles of systemic chemotherapy, and no adverse events. Glehen et al. [48]
suggested that HIPEC should be reserved for patients with limited peritoneal carcinomatosis. Also, the
[46]
prognostic factors analyzed by Yang et al. suggests that it should be restricted to a limited patient
population.

Role of laparoscopy in patient selection for CRS and HIPEC
Laparoscopy has been suggested as an important modality for selecting patients for aggressive treatments
with CRS and HIPEC. Even today with high technology radiology studies, diagnostic laparoscopy remains