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Intro -- 00_Prelims_GST Manual_7E -- 0 Finance Act 2021 -- A1 0 OPENER- -- A1_CGST Act, 2017 -- A2_CGST Rules_2017-15-02-21 -- A3. CGST Notifications (Non-tariff) -- B1 0 OPENER- -- B1_IGST Act, 2017 -- B2_IGST Rules, 2017-15-02-21 -- B3. IGST Notifications (Non-tariff) -- C1 0 OPENER -- C1_GST (Compensation to States) Act, 2017 -- C2_GST Compensation Cess Rules, 2017 -- C3. Compensation Cess Notifications (Non-tariff)) -- D_0 OPENER -- D_GST Forms -- E1 0 OPENER -- E1_List of Circulars -- E2_List of Orders -- E3_CBEC measures during outbreak of COVID-19.

BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has recently emerged as a viable management option for peritoneal surface malignancy (PSM). CRS and HIPEC is a complex, multidisciplinary and resource-intensive surgical procedure. It has a steep learning curve and is associated with significant morbidity and mortality. The expertise is mostly limited to few dedicated high-volume centers located in developed countries. We present a single institutional experience of 232 cases of CRS and HIPEC performed at a tertiary care cancer center in a low- and middle-income country (LMIC). METHODS: A multidisciplinary PSM program was initiated in 2015 at a high-volume public-sector tertiary care cancer center in North India catering largely to patients belonging to low- and middle-income groups. Perioperative protocols were developed, and a prospective structured database was created to capture data. All patients undergoing CRS and HIPEC between January 2015 and December 2020 were identified, and the data was retrospectively analyzed for clinical spectrum, surgical details, and perioperative morbidity and mortality. RESULTS: Two hundred and thirty-two patients underwent CRS and HIPEC during the study period. Epithelial ovarian carcinoma (56.5%) was the most common malignancy treated, followed by pseudomyxoma peritonei (18.5%), colorectal carcinoma (13.4%), and malignant mesothelioma (5.6%). Optimal CRS could be achieved in 94.4% of patients. Cisplatin and mitomycin were the most common drugs used for HIPEC. A total of 28.0% of patients had morbidity including deep vein thrombosis, subacute intestinal obstruction, sepsis, burst abdomen, lymphocele, urinoma, acute renal failure, and enterocutaneous fistula. The overall treatment-related mortality was 3.5%. CONCLUSIONS: Results of the current study indicate that it is feasible to establish a successful CRS and HIPEC program for PSM in government-funded hospitals in LMIC facing resource constraints. The most common indication for CRS ...