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Review
. 2025 Jun 25.
doi: 10.1245/s10434-025-17362-1. Online ahead of print.

Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

Varun V Bansal #  1 , Elizabeth L Godfrey #  1 , Javid Sadjadi  2 , Ricardo J Bello  3 , Riom Kwakman  4 , Andres A Abreu  5 , Vignesh Vudatha  6 , Brian K Sparkman  6 , Devon C Freudenberger  6 , David G Su  1 , Kiran K Turaga  7 , Dejan Micic  8 , Monica Malec  8 , Sandy Tun  8 , Blasé Polite  8 , Laura A Lambert  9 , Alissa Greenbaum  2 , Craig G Gunderson  1 , Thomas J Smith  10 , Kimberly E Kopecky  11 , Benjamin D Powers  12 , Ugwuji N Maduekwe  3 , Erin P Ward  9 ; Peritoneal Surface Malignancies (PSM) Consortium Group
Collaborators, Affiliations
Review

Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

Varun V Bansal et al. Ann Surg Oncol. .

Abstract

Background: Malignant gastrointestinal obstruction (MGIO), a frequent complication of peritoneal surface malignancies (PSM), often portends a poor prognosis. The lack of high-quality evidence on optimal management strategies necessitated a national consensus to address this clinical problem.

Methods: A clinical management pathway was designed through a Delphi consensus process with national experts in peritoneal disease. Two rounds of voting were conducted to assess agreement levels with pathway blocks. Supporting evidence regarding procedural interventions for MGIO underwent evaluation via a rapid literature review.

Results: Of 111 participants responding in the first round, 90 (81%) responded in the second round. Over 90% consensus was achieved in 4/6 and 6/6 pathway blocks during rounds I and II, respectively. Encouraging a multidisciplinary approach, the pathway emphasized early palliative care assessments and iterative goals of care evaluation throughout treatment. Management was delineated on the basis of obstruction acuity, and selection criteria for palliative-intent surgical interventions and stenting were elucidated. Studies demonstrated limited benefits for such interventions in patients with multifocal obstructions, poor performance status, and high-grade and/or high-burden PSMs. In these cases, a recommendation for supportive care or upper GI decompression tube placement was favored. The overall level of evidence was generally low-moderate in existing literature.

Conclusions: Given limited evidence, the consensus-driven pathway provides crucial clinical guidance for practitioners dealing with MGIO in patients with PSM. There is a need for high-quality prospective evidence in this domain.

Keywords: Cytoreductive surgical procedures; Guidelines; Intestinal obstruction; Peritoneal neoplasms; Peritoneal surface malignancies.

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Conflict of interest statement

Disclosure: Dejan Micic has received advisory board consulting fees from Takeda Pharmaceuticals USA, Inc. outside the submitted work. Blasé Polite has received speaking and consulting fees from Natera, Inc., Alpine Immune Sciences, and Aileron Therapeutics outside the submitted work. Kiran Turaga 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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