ABSTRACT
A structured approach is required for cytoreductive surgery (CRS) assessing and dealing with each quadrant guided by the redistribution phenomenon for peritoneal disease. In general, CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) procedures can be divided into four operative phases such as Exploratory phase, Cytoreductive phase, HIPEC and Reconstructive phase. A right and/or left parietal peritonectomy is often performed during the exploratory phase to facilitate access to the abdominal cavity and retroperitoneal structures. In patients undergoing a rectum-preserving pelvic peritonectomy, the rectum must be closely inspected for any serosal tears; use of a Heald anal stent may be considered in these patients to ensure adequate rectal decompression. The omentum is divided from the greater curvature of the stomach, starting with transfixion of the right gastro-epiploic vessels at the right lateral aspect of the greater curvature and continuing with stepwise ligation of the short gastric vessels.
