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. 2025 Jun 25.
doi: 10.1245/s10434-025-17360-3. Online ahead of print.

Consensus Guideline for the Management of Peritoneal Metastases from Neuroendocrine Neoplasms

David G Su  1 , Leanne M Brown  1 , Varun V Bansal  1 , Baylee Bakkila  1 , Seth J Concors  2 , Kiran K Turaga  3 , Craig Gunderson  1   4 , Emily Bergsland  5 , Jonathan R Strosberg  6 , Thorvardur R Halfdanarson  7 , David C Metz  8 , John W Kunstman  1 , Pamela L Kunz  1 , Alexandra Gangi  9 ; Peritoneal Surface Malignancies (PSM) Consortium Group
Collaborators, Affiliations

Consensus Guideline for the Management of Peritoneal Metastases from Neuroendocrine Neoplasms

David G Su et al. Ann Surg Oncol. .

Abstract

Background: Neuroendocrine neoplasms (NEN) with peritoneal metastases (PM) represent a complex clinical challenge due to low incidence and heterogeneous phenotypes. This manuscript describes the results of a national consensus aimed at addressing clinical management of patients with NEN-PM.

Methods: An update of the 2018 Chicago consensus guidelines was conducted using a modified Delphi technique, encompassing two rounds of voting. The levels of agreement for various pathway blocks were assessed. Key systemic therapy concepts were summarized by content experts. Supporting evidence was evaluated via a rapid literature review.

Results: Overall, the level of evidence for the management of PM in this disease was universally low. In total, 107 participants responded in the first round, with 88/107 (82%) participating in the second round. Strong consensus (> 90%) was achieved in 5/7 (71%) and 7/7 (100%) blocks in rounds I and II respectively. A multidisciplinary approach including psychosocial and wellness assessments received a strong positive recommendation. Management of NENs with PM was organized according to disease grade and symptom profiles. In grade 1 and 2 well-differentiated NENs, cytoreductive surgery (CRS) received strong support (>95%) following the management of functional syndromes (if present). For grade 3 well-differentiated NENs, systemic therapy is the primary recommendation, with surgical resection considered in select cases.

Conclusion: Given limited evidence, the consensus-driven clinical pathway offers vital clinical guidance for the management on NENs with PM. The need for high-quality evidence remains critical to the field.

Keywords: Clinical guidelines; Cytoreductive surgery; Neuroendocrine neoplasms; Peritoneal surface malignancies; Peritoneal surface neoplasms.

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Conflict of interest statement

Disclosure: JRS is on the Speakers’ Bureau of Ipsen and Tersera and is a consultant for Novartis. TRH has received research support from Thermo Fisher Scientific, Advanced Accelerator Applications, Camurus, Crinetics, and ITM Isotopen Technologien Muenchen and has consulted or has been a part of an Advisory Board or Steering Committee for Ipsen, TerSera, Advanced Accelerator Applications, ITM Isotopen Technologien Muenchen, Crinetics, Viewpoint Molecular Targeting, and Camurus. PLK has participated in advisory boards for Amgen, Crinetics, Genentech, HutchMed, Ipsen, Natera, Novartis (Advanced Accelerator Applications) and RayzeBio, received research funding from Lexicon, Ipsen, Xencor, Brahms, Novartis (Advanced Accelerator Applications). KKT has received speaking fees from Aspire Bariatrics and Consulting fees from Merck and Co. outside of the submitted work. Other authors have no relevant financial disclosures. Ethical approval: Not applicable. Consent for publication: Not applicable. Declaration of Generative AI and AI-assisted technologies in the writing process: During the preparation of this work the authors used a large language model (ChatGPT V3.5) to revise the manuscript text for coherence and clarity. After using this service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

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