Granieri S, Bonomi A, Frassini S, et al. - By analyzing data from randomized studies only, researchers sought to determine how cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) impacts survival in gastric cancer patients. Following PRISMA guidelines, a systematic review of articles was performed. A qualitative and quantitative analysis was carried out with 12 studies. For patients receiving CRS + HIPEC, the 1, 2, 3 and 5-year survival rates (SR) were estimated to be 86.9%, 70.5%, 63.7% and 55.7% respectively. The only predictor of a decreased 3y SR was CRS + HIPEC for the treatment instead of prophylaxis of peritoneal metastases. Findings indicate that improved prognosis of locally advanced gastric cancer may be conferred by CRS + HIPEC, in both prophylactic and curative settings. Due to far from negligible postoperative morbidity and mortality rates, it is very important that a strict patient selection is implemented so that the best results may be obtained. Extraperitoneal disease, if present, strongly limits the indication of this type of surgery.