Updated Peritoneal Surface Malignancy Guidelines Aim to Remedy Disparities in Care

Peritoneal surface malignancies affect nearly 70,000 patients in the US annually.¹ This year, for the first time since the 2018 Chicago Consensus, new clinical guidelines outlining a unified approach to treating the disease were published.²

The consortium consisted of researchers, physicians, patient organizations, trainees, and allied professionals, all of whom helped create the outline. Kiran Turaga, MD, MPH, was the research lead of this undertaking. He spoke with CancerNetwork® about the significance of these new guidelines.

One of the largest problems with peritoneal surface malignancies is that they’re difficult to image; thus, often when they’re found, the disease is already advanced. These guidelines sought to address and remedy that problem.

Turaga, a professor of surgical oncology, assistant medical director of the Clinical Trials Office, and division chief of Surgical Oncology and Surgery at Yale Cancer Center, also spoke about the role trainees had in this consortium, and particularly about how he believes they are “the future” of peritoneal surface malignancy care. He also spoke of a hope of uniting the experts behind a singular method of treating this disease.

Transcript:

Peritoneal metastases are a common site of metastases for a lot of [gastrointestinal] cancers and [gynecologic] cancers, and there are some primary peritoneal malignancies like mesothelioma. There are about 70,000 to 80,000 patients in the US who are affected by this. The challenge with peritoneal metastases is that they’re difficult to image on scans. What ends up happening is that, many times, patients are excluded from clinical trials. We found that for colon cancer peritoneal metastases, of the studies that have looked at 50,000 patients, barely anyone [with peritoneal metastases was enrolled on] clinical trials.

For surgeons, we often get imaging scans and CT scans, and don’t see peritoneal metastases. The patients are feeling great, they come for their oncology visits, they feel like they’re doing okay, and then suddenly they’re there with bowel obstructions, and are going to hospice or are dying. There’s a critical need for addressing how to manage patients with peritoneal metastases that is distinct. Why? No.1, they’re not in clinical trials. No. 2, by the time surgeons and other specialists are getting to these patients, the disease is quite advanced. Therefore, we proposed these guidelines, thinking about how we address this unmet need and this critical gap in the management of these patients. These guidelines are a set of documents—this is about 7 papers looking at different pathways, which are jointly published in both Cancer and the Annals of Surgical Oncology.

Reference

1. Hazell N. Best practices for peritoneal surface malignancies: a Yale-led national expert consensus. Yale School of Medicine. June 27, 2025. Accessed July 15, 2025. https://tinyurl.com/2vn7d5tu
2. Butensky SD, Bansal VV, Su DG, et al. Consensus guideline for the management of gastric cancer with synchronous peritoneal metastases. Ann Surg Oncol. Published online June 25, 2025. doi:10.1245/s10434-025-17361-2