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Background <p>The peritoneum is a common site of metastases from colorectal cancer (CRC), yet controversy exists regarding optimal treatment strategies. These guidelines describe the results of a national consensus addressing the management of CRC with peritoneal metastases (CRC-PM).</p> Methods <p>An update of the 2018 Chicago Consensus Guidelines was conducted using a modified Delphi technique. Two rounds of voting were performed to assess agreement levels on two clinical management pathways regarding synchronous and metachronous CRC-PM. Supporting evidence was evaluated via rapid literature reviews.</p> Results <p>The overall level of evidence was low in existing literature. Of 145 participants in the first round, 136 (96.8%) responded in the second round. Over 90% consensus was achieved in most pathway blocks. For both pathways, early referral to a peritoneal surface malignancy (PSM) center should be made for patients with CRC-PM. For the synchronous pathway, upfront cytoreductive surgery was de-emphasized in favor of systemic therapy. For the metachronous pathway, risk stratification via clinical and pathologic features was revised. For both pathways, surveillance strategies were added, including only a weak recommendation for circulating tumor DNA (ctDNA) testing given limited evidence of its utility in detecting and monitoring PM.</p> Conclusion <p>The consensus-driven clinical pathways provide valuable guidance for the management of CRC-PM. There remains a need for high-quality evidence and prospective multicenter trials in this domain.</p>

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Consensus Guideline for the Management of Colorectal Cancer with Peritoneal Metastases

  • 期刊论文

  • 发表日期：

    2025年6月25日

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  • Kurt S. Schultz,
  • Varun V. Bansal,
  • Michael M. Wach,
  • Neal Bhutiani,
  • Frederick A. Godley IV,
  • Jaeyun Jane Wang,
  • Muhammad Talha Waheed,
  • Joanna T. Buchheit,
  • Emily Papai,
  • Susan Campbell,
  • Lauren E. Schleimer,
  • David G. Su,
  • Kiran K. Turaga,
  • Craig G. Gunderson,
  • Michael G. White,
  • Abhineet Uppal,
  • Kanwal P. S. Raghav,
  • Daniel M. Labow,
  • Umut Sarpel,
  • Ardaman P. Shergill,
  • John Paul Shen,
  • Cathy Eng,
  • Michael B. Foote,
  • Joel M. Baumgartner,
  • Adam Khader,
  • Ahmed Hamed,
  • Al B. Benson III,
  • Alan Venook,
  • Alex Fisher,
  • Alex Kim,
  • Alexander Loftus,
  • Alexander S. Thomas,
  • Alexandra Gangi,
  • Alicia Greene,
  • Alissa Greenbaum,
  • Amanda Arrington,
  • Amer K. Abu Alfa,
  • Ana Gleisner,
  • Anai Kothari,
  • Anand Govindarajan,
  • Andreana N. Holowatyj,
  • Andrei Nikiforchin,
  • Andres Abreu,
  • Andrew Łowy,
  • Andrew M. Bellizzi,
  • Ankit Dhiman,
  • Anthony Villano,
  • Antoine Bouchard-Fortier,
  • Anwaar Saeed,
  • Aparna Raj Parikh,
  • Armando Sardi,
  • Avinoam Nevler,
  • Baylee Bakkila,
  • Beatrice Sun,
  • Benjamin Powers,
  • Beth Helmink,
  • Biren Reddy,
  • Blase Polite,
  • Bradley White,
  • Brian Sparkman,
  • Byrne Lee,
  • Caitlin Hester,
  • Carla Harmath,
  • Carlos Chan,
  • Carrie Luu,
  • Catalina Mosquera,
  • Charles J. Schneider,
  • Charles Staley,
  • Christopher Lieu,
  • Chukwuemeka Ihemelandu,
  • Colette Brottman,
  • Colette Pameijer,
  • Colin Court,
  • Conor O’Neill,
  • Dan Blazer,
  • Daniel Abbott,
  • Daniel Milgrom,
  • Daniel Tuvin,
  • Darryl Outlaw,
  • Darryl Schuitevoerder,
  • David Bartlett,
  • David Bentrem,
  • David Hanna,
  • David Ilson,
  • Deepa Magge,
  • Marcello Deraco,
  • Devon Freudenberger,
  • Deyali Chatterjee,
  • Diane Reidy-Lagunes,
  • Dipen Maru,
  • Divya Sood,
  • Edward Levine,
  • Ekaterina Baron,
  • Elizabeth Godfrey,
  • Elizabeth Olecki,
  • Emmanuel Gabriel,
  • Eric Pletcher,
  • Erin P. Ward,
  • Fabian Johnston,
  • Fadi Dahdaleh,
  • Farin Amersi,
  • Felipe Lopez-Ramirez,
  • Filip Bednar,
  • Forest Mahoney,
  • Francisco Izquierdo,
  • Garrett Nash,
  • Gary N. Mann,
  • George Salti,
  • Georgios Georgakis,
  • Georgios Karagkounis,
  • Gilbert Murimwa,
  • Giorgos Karakousis,
  • Haejin In,
  • Hallbera Gudmundsdottir,
  • Hanlin L. Wang,
  • Hanna Sanoff,
  • Harveshp Mogal,
  • Hatem Halabi,
  • Hunter Witmer,
  • Ian Solsky,
  • Ioannis Konstantinidis,
  • Ira L. Leeds,
  • J. Randolph Hecht,
  • Jackson Baril,
  • Jacquelyne J. Gaddy,
  • James Campbell Cusack Jr,
  • James W. Fleshman,
  • Jason Foster,
  • Jason L. Hornick,
  • Javid Sadjadi,
  • Jeff Sussman,
  • Jeffrey M. Sutton,
  • Jennifer Keller,
  • Jeremy Sharib,
  • Jesus Esquivel,
  • Jig Deneve,
  • John Hart,
  • John Hays,
  • Jonathan B. Greer,
  • Jordan Cloyd,
  • Jorge L. Gomez,
  • Joseph Kim,
  • Joshua Winer,
  • Jula Veerapong,
  • Jun Gong,
  • Kamran Idrees,
  • Katrina S. Pedersen,
  • Kay Washington,
  • Kevin Sullivan,
  • Kimberly Johung,
  • Kimberly Kopecky,
  • Konstantinos Chouliaras,
  • Kostas Votanopoulos,
  • Kristina A. Matkowskyj,
  • Laura Lambert,
  • Lauren Raymond,
  • Leanne Brown,
  • Leonard Saltz,
  • Leopoldo Fernandez,
  • Lindy Davis,
  • Lloyd Mack,
  • Madeline B. Torres,
  • Maheswari Senthil,
  • Manish Shah,
  • Manju George,
  • Marcovalerio Melis,
  • Maria Russell,
  • Marie Robert,
  • Mary Garland-Kledzik,
  • Mason Vierra,
  • Masoumeh Ghayouri,
  • Mazin Al-Kasspooles,
  • Mecker Moller,
  • Mehraneh D. Jafari,
  • Melanie Ongchin,
  • Melissa Taggart,
  • Michael Cecchini,
  • Michael D. Kluger,
  • Michael White,
  • Mikaël Soucisse,
  • Mohamed Adam,
  • Mohammad Haroon Asif Choudry,
  • Mohammed Suraju,
  • Mojgan Hosseini,
  • Monica Malec,
  • Mustafa Raoof,
  • Nabil Wasif,
  • Nadège Fackche,
  • Nader Hanna,
  • Namrata Vijayvergia,
  • Nancy Baxter,
  • Nelya Melnitchouk,
  • Nikoloas Dallas,
  • Niraj J. Gusani,
  • Oliver Eng,
  • Olivier Glehen,
  • Pathik Aravind,
  • Patricio Polanco,
  • Patrick Wagner,
  • Paul Helft,
  • Paul Sugarbaker,
  • Pompiliu Piso,
  • Prakash Pandalai,
  • Quan P. Ly,
  • Rachel Kim,
  • Rachyl Shanker,
  • Raed Al-Rajabi,
  • Raghav Sundar,
  • Rajiv Agarwal,
  • Randall Zuckerman,
  • Rebecca Wiatrek,
  • Ricardo Bello,
  • Richard Alexander,
  • Richard Berri,
  • Richard Hoehn,
  • Richard Royal,
  • Rifat Mannan,
  • Riom Kwakman,
  • Rita Akumuo,
  • Robert Barone,
  • Robert Sticca,
  • Rupen Shah,
  • Ryan Merkow,
  • Sabha Ganai,
  • Sam George Pappas,
  • Samantha Ruff,
  • Sameer Patel,
  • Samer Naffouje,
  • Samuel Butensky,
  • Sanjay Bagaria,
  • Sara Daniel,
  • Sarah Wilkins,
  • Scott Sherman,
  • Sean Dineen,
  • Seth Concors,
  • Shannon Radomski,
  • Sherif Abdel-Misih,
  • Stacey Cohen,
  • Stacey Stein,
  • Stephanie Greco,
  • Steven Ahrendt,
  • Steven Libutti,
  • T. Clark Gamblin,
  • Taylor Jaraczewski,
  • Thinzar Lwin,
  • Thorvardur Halfdanarson,
  • Trang Nguyen,
  • Travis Grotz,
  • Ugwuji Maduekwe,
  • Uqba Khan,
  • Vadim Gushchin,
  • Vignesh Vudatha,
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  • Wenyi Luo,
  • Wilbur B. Bowne,
  • William Morano,
  • Xavier Keutgen,
  • Xiang Gao,
  • Yan Li

摘要

Background

The peritoneum is a common site of metastases from colorectal cancer (CRC), yet controversy exists regarding optimal treatment strategies. These guidelines describe the results of a national consensus addressing the management of CRC with peritoneal metastases (CRC-PM).

Methods

An update of the 2018 Chicago Consensus Guidelines was conducted using a modified Delphi technique. Two rounds of voting were performed to assess agreement levels on two clinical management pathways regarding synchronous and metachronous CRC-PM. Supporting evidence was evaluated via rapid literature reviews.

Results

The overall level of evidence was low in existing literature. Of 145 participants in the first round, 136 (96.8%) responded in the second round. Over 90% consensus was achieved in most pathway blocks. For both pathways, early referral to a peritoneal surface malignancy (PSM) center should be made for patients with CRC-PM. For the synchronous pathway, upfront cytoreductive surgery was de-emphasized in favor of systemic therapy. For the metachronous pathway, risk stratification via clinical and pathologic features was revised. For both pathways, surveillance strategies were added, including only a weak recommendation for circulating tumor DNA (ctDNA) testing given limited evidence of its utility in detecting and monitoring PM.

Conclusion

The consensus-driven clinical pathways provide valuable guidance for the management of CRC-PM. There remains a need for high-quality evidence and prospective multicenter trials in this domain.