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Review
. 2025 Jun 25.
doi: 10.1245/s10434-025-17363-0. Online ahead of print.

Consensus Guideline for the Management of Colorectal Cancer with Peritoneal Metastases

Kurt S Schultz  1 , Varun V Bansal  1 , Michael M Wach  2 , Neal Bhutiani  3 , Frederick A Godley 4th  4 , Jaeyun Jane Wang  5 , Muhammad Talha Waheed  6 , Joanna T Buchheit  7 , Emily Papai  8 , Susan Campbell  9 , Lauren E Schleimer  10 , David G Su  1 , Kiran K Turaga  11 , Craig G Gunderson  12   13 , Michael G White  3 , Abhineet Uppal  3 , Kanwal P S Raghav  14 , Daniel M Labow  15 , Umut Sarpel  16 , Ardaman P Shergill  17 , John Paul Shen  14 , Cathy Eng  18 , Michael B Foote  19 , Joel M Baumgartner  20 ; Peritoneal Surface Malignancies (PSM) Consortium Group
Collaborators, Affiliations
Review

Consensus Guideline for the Management of Colorectal Cancer with Peritoneal Metastases

Kurt S Schultz et al. Ann Surg Oncol. .

Abstract

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.

Keywords: Colon cancer; Colorectal cancer; Cytoreductive surgery; Guidelines; Intraperitoneal chemotherapy; Peritoneal surface malignancies; Peritoneal surface neoplasms; Rectal cancer; ctDNA.

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Conflict of interest statement

Disclosures: FAG received research funding from Intuitive Surgical outside the submitted work. KKT has received speaking fees from Aspire Bariatrics and consulting fees from Merck and Co. outside of the submitted work. KPSR has received consulting fees from or served on the advisory board for AstraZeneca, Bayer, Eisai, Daiichi Sankyo, and Seattle Genetics outside the submitted work. KPSR has research funding from the NIH CCSG Award (P30 CA016672) outside the submitted work. APS has served on the advisory board for Pfizer, Guardant, and Natera and has received travel, registration, and accommodation support for presenting at AACR from Takeda outside the submitted work. APS has research funding from the following entities in which funds are provided directly to the University of Chicago: Hutchison MediPharma, Merck, Verastem Oncology, Turning Point Therapeutics, Gritstone, Bolt Therapeutics, BMS, Pfizer, Astellas, Oncologie, Macogenics, Seattle Genetics, Amgen, Daiichi, Lilly, Jacobio, and Takeda outside the submitted work. CE has a consulting or advisory role for GlaxoSmithKline, Natera, Janssen Oncology, General Electric, Merck Serono, Elevation 5 Oncology, Seagen, Pfizer, Elevar Therapeutics (Inst), Merck (Inst), Pfizer (Inst), Gritstone Bio (Inst), Amgen (I), California Institute for Regenerative Medicine (CIRM) (I), IgM Biosciences (I), Taiho Oncology (I) outside the submitted work. CE has research funding from Hutchison MediPharma (Inst), Merck (Inst), Gritstone Bio (Inst), Janssen Oncology (Inst), Pfizer (Inst) outside the submitted work. JPS has received personal fees from Nadeno Nanoscience and Engine Bioscience, grants from Celsius Therapeutics outside the submitted work, holds a patent for small molecule GNAS inhibitors, and serves on the Medical Advisory Board for Appendix Cancer Pseudomyxoma Peritonei Research Foundation (unpaid). Other authors have no relevant financial disclosures. 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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