Systematic second-look surgery with

Systematic second-look surgery with HIPEC for CRC patients who are at highrisk for developing PM has aroused a growing interest among the scientificcommunity. The concept was first used by Wangensteen in 1948 [97]. Theprinciples are based on the use of planned relaparotomy in asymptomaticpatients with malignant disease who considered to be at risk for developingrecurrent or metastatic disease despite (i) initial curative surgery and (ii) absence of any apparent clinical or imaging abnormality [98]. As it is a ratheraggressive and costly treatment, it should be restricted exclusively to highlyselected patients presenting a high risk of developing PC. A major proportion ofthe at-risk population has recently been defined by Elias et al. and concerns: (i) patients presenting a few nodules of synchronous PC which arecompletely resected with the primary tumor, (ii) patients with ovarian metastases, and (iii) patients with a perforated primary tumor (spontaneous oriatrogenic) or accidental intraoperative tumor spillage