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Review
. 2025 Jun 25.
doi: 10.1245/s10434-025-17361-2. Online ahead of print.

Consensus Guideline for the Management of Gastric Cancer with Synchronous Peritoneal Metastases

Samuel D Butensky  1 , Varun V Bansal  1 , David G Su  1 , Muhammad Talha Waheed  2 , Andrei Nikiforchin  3 , Jorge L Gomez-Mayorga  4 , Elizabeth Olecki  5 , Shannon N Radomski  6 , Beatrice Sun  7 , Kiran K Turaga  8 , Craig G Gunderson  1 , Jill Lacy  1 , Brian D Badgwell  9 , Haejin In  10 , Timothy Kennedy  10 , Harry H Yoon  11 , Jonathan B Greer  12 , Raghav Sundar  13 , Yanghee Woo  2 ; Peritoneal Surface Malignancies (PSM) Consortium Group
Collaborators, Affiliations
Review

Consensus Guideline for the Management of Gastric Cancer with Synchronous Peritoneal Metastases

Samuel D Butensky et al. Ann Surg Oncol. .

Abstract

Background: Gastric cancer with synchronous peritoneal metastases (GCPM) is a debilitating disease with limited treatment options. This manuscript describes an update of the 2018 Chicago Consensus Guidelines addressing the management of GCPM in line with most recent evidence.

Methods: A clinical management pathway was updated through two rounds of a Delphi Consensus to assess agreement levels with pathway blocks. Supporting evidence underwent evaluation via a rapid literature review. Meta-analyses were performed where appropriate.

Results: Overall, level of evidence in this disease subset was low to moderate. Of 124 participants in the first round, 109 (88%) responded in the second round. Strong consensus (>90%) was achieved in 6/8 (75%) blocks in round I and II. A multidisciplinary preoperative assessment and diagnostic laparoscopy should be offered to all patients, while patients with a high burden of disease or progression should undergo non-surgical management. Patients with stable/responsive disease and low peritoneal carcinomatosis index should subsequently be offered treatment with regional therapeutic interventions and cytoreductive surgery. In patients who are cytology positive, systemic therapy can be used to convert these patients to cytology negative, with subsequent surgery offered per the patient's goals of care. Meta-analysis of observational and randomized control trials revealed a survival benefit with the addition of intraperitoneal chemotherapy to cytoreductive surgery (HR 0.52).

Conclusion: The consensus-driven clinical pathway for GCPMs offers vital clinical guidance for practitioners. There is a growing body of high-quality evidence to support management strategies and future clinical trials are eagerly awaited.

Keywords: Cytoreductive surgical procedures; Gastric cancer; Guidelines; Peritoneal surface malignancies; Peritoneal surface neoplasms.

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Conflict of interest statement

Disclosure: JL consults and/or serves in an advisory role for Ipsen, Novartis, Deciphera, Merck, Equinox, Techspert, Guidepoint, KeyQuest, FirstWorld Group, Aptitude Health, and Brass Tacks Health. HHY declares honoraria from Astellas, Elevation Oncology, MJH Life Sciences, and PRIME; consulting or advisory role for ALX Oncology, Amgen, AstraZeneca, BeiGene, Bristol Myer Squibb, Macrogenics, Merck, Novartis, OncXerna, and Zymeworks; expert testimony for MJH Life Sciences; travel/accommodations/expenses from Astellas, BeiGene, Elevation Oncology, and PRIME. KKT has received speaking fees from Aspire Bariatrics and Consulting fees from Merck and Co. outside of the submitted work. YW is a member of the scientific advisory board of Imugene LTD and J&J Ethicon. RS reports attending advisory board meetings for Bristol Myers Squibb, Merck, Eisai, Bayer, Taiho, Novartis, MSD, GSK, DKSH, Astellas, Pierre-Fabre, Tavotek; receiving honoraria for talks from MSD, Eli Lilly, BMS, Roche, Taiho, Astra Zeneca, DKSH, Ipsen, Daiichi Sankyo, Beigene, Astellas; receiving travel support from Roche, Astra Zeneca, Taiho, Eisai, DKSH, Ipsen, Paxman Coolers, Cytomed Therapeutics; receiving research funding from Paxman Coolers, MSD, Natera, CytoMed Therapeutics and has patents pending with licensing to Paxman and Auristone. Other authors have no relevant financial disclosures. Ethical Approval and Consent to participate: 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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