LAUSR

I appreciate the commentary from Souadka et al. regarding our manuscript evaluating the potential benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) for cases of incomplete cytoredu-cion. 1 Addressing the questions raised in the commentary the first was an inquiry of the extent of viscera resected in those incomplete cytoreduction cases. For cases undergoing incomplete cytoreductive surgery (CRS), as defined by an R2b or R2c cytoreduction, 62% involved a colectomy, 12% involved a proctectomy, 41% involved a small bowel resection, 19% involved a gastrectomy, 51% involved a splenectomy, and 11% involved a pancreatectomy. Other organs such as the liver, uterus, and diaphragm were resected in less than 5% of cases. Nearly all cases involved multiple visceral resections. When performing CRS ‐ HIPEC at our institution for appendiceal and colorectal primaries the extent of peritonectomy is limited to resection of gross disease only, total peritonectomies are typically reserved for peritoneal mesothelioma cases. The second question regarded what proportion did those incomplete cytoreduction cases comprise within our institutional experience. At the time of study analysis those 121 incomplete CRS cases represented only 10% of our collective institutional volume of over 1200 cases between our appendiceal and colorectal CRS ‐ HIPEC registries. As the Souadka commentary rightly pointed out the ability to achieve a complete cytoreduction is a surrogate