Surgery
STERILE, DISEASE
Laparoscopic CRS/HIPEC was performed via a closed technique. Patients were positioned split-leg with adequate stabilization to allow for positional changes including steep Trendelenburg and reverse Trendelenburg positioning, well as side-to-side tilting. Thorough, systematic exploration for disease was performed starting with the upper abdomen, using a 30 degree laparoscope. All parietal peritoneal surfaces were inspected including in the pelvis. The gastrocolic ligament was incised and the lesser sac was inspected. The ligament of Treitz was identified and inspected and the small bowel was run from there to the ileocecal valve, examining the serosa and the mesenteric surfaces. Finally, the intraperitoneal colon was inspected as were the para-colic gutters.Once all sites of disease were identified, laparoscopic cytoreduction was performed, including selective peritonectomy. Specimens were placed in a sterile bag and removed via an existing port site, or via an enlarged port site lined with a wound protector. HIPEC catheters were then inserted via the existing port sites and/or the extraction site. HIPEC was performed with mitomycin C (MMC) as previously described [Operative photos showing standard open incision for CRS/HIPEC extending from xiphoid process to pubic symphysis (