To the Editor, We read with great interest the article written by Mangieri et al., 1 which outlines for the first time the question of heated intraperitoneal chemotherapy (HIPEC) utility for incomplete cytoreduction surgery (ICRS). Indeed, determining the benefit of HIPEC in such situations and whether overall survival (OS) or progression-free survival (PFS) advantages exist is crucial. That being said, we would like to stress a few points.The extent of the resection is a self-reported operative outcome, which depends on the organs involved in the procedure and whether it was a peritonectomy with or without a coloproctectomy, a splenopancreatectomy, a gastrectomy, or other complex resections. 2 However, no details of the types of resections, nor the proportions of R2b and R2c resections have been specified by the authors.

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Cervical cancer is the second most common cancer and the third cause of cancer death in women. Radiotherapy occupies a prominent place in the therapeutic arsenal of cervical cancer in localized stages. Radiation induced secondary cancer is an entity that has been well described in the literature. We report a case of a rectal adenocarcinoma occurring in a woman previously treated by radiotherapy and brachytherapy for a squamous cell carcinoma of the cervix.

Aim Peritoneal surface malignancy (PSM) programmes offer curative options to previously terminal cases through cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, this requires special expertise and resources, which may not be available to low- and middle-income countries (LMIC). The study aims to document the Moroccan experience of a national PSM programme. Method This is a mixed method study involving the retrospective assessment of patients with PSM following CRS between 2004 and 2018, alongside interviewing the founding surgeons leading the programme establishment to depict the pitfalls, difficulties, and processes of a PSM programme creation. This operation extended on an initiation, transition, and consolidation phase. Progress was demonstrated by outcome comparison of incomplete cytoreductive surgery (ICRS) rate, serious complications ≥ 3b according to the Clavien-Dindo scoring, and early oncologic failure (EOF; disease progression within 2 years of treatment) between periods. Results In total, 198 CRS procedures were performed in the three phases with outcome assessment showing significantly better results with lower ICRS (34%, 18% and4% p=<0.001), serious complications (30.6%, 20% and11.2%, p=0.019), and EOF (38.8%, 23.3% and12.4% p=0.002). Programme founders highlighted the importance of project initiators’ motivation and leadership qualities, team readiness to overcome resource’ restrictions while improving their surgical expertise in CRS techniques, and collaborations development to reinforce multidisciplinary and institutional progress before adding HIPEC. Conclusions Implementing a PSM programme in a LMIC can be a challenging process, which motivation, training and good resources usability can help overcome.