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Background <p>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.</p> Methods <p>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.</p> Results <p>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 (&gt;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).</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年6月25日

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  • Samuel D. Butensky,
  • Varun V. Bansal,
  • David G. Su,
  • Muhammad Talha Waheed,
  • Andrei Nikiforchin,
  • Jorge L. Gomez-Mayorga,
  • Elizabeth Olecki,
  • Shannon N. Radomski,
  • Beatrice Sun,
  • Kiran K. Turaga,
  • Craig G. Gunderson,
  • Jill Lacy,
  • Brian D. Badgwell,
  • Haejin In,
  • Timothy Kennedy,
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  • Abhineet Uppal,
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  • Al B. Benson III,
  • Alex Fisher,
  • Alex Kim,
  • Alexander Loftus,
  • Alexander S. Thomas,
  • Alexandra Gangi,
  • Alicia Greene,
  • Alissa Greenbaum,
  • Amanda Arrington,
  • Amer K. Abu Alfa,
  • Anai Kothari,
  • Anand Govindarajan,
  • Andreana N. Holowatyj,
  • Andres Abreu,
  • Andrew M. Bellizzi,
  • Ankit Dhiman,
  • Anthony Villano,
  • Antoine Bouchard-Fortier,
  • Anwaar Saeed,
  • Armando Sardi,
  • Ashley Efrain Alarcon Rozas,
  • Avinoam Nevler,
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  • Beth Helmink,
  • Biren Reddy,
  • Bradley White,
  • Brian Sparkman,
  • Byrne Lee,
  • Caitlin Hester,
  • Carla Harmath,
  • Carlos Chan,
  • Carrie Luu,
  • Catalina Mosquera,
  • Charles Staley,
  • Chukwuemeka Ihemelandu,
  • Colette Brottman,
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  • Colin Court,
  • Conor O’Neill,
  • Dan Blazer,
  • Daniel King,
  • Daniel Labow,
  • Daniel Milgrom,
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  • Darryl Outlaw,
  • Darryl Schuitevoerder,
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  • David Bentrem,
  • David Hanna,
  • David Ilson,
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  • Devon Freudenberger,
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  • Elizabeth Godfrey,
  • Emily Papai,
  • Emmanuel Gabriel,
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  • Fabian Johnston,
  • Fadi Dahdaleh,
  • Felipe Lopez-Ramirez,
  • Filip Bednar,
  • Forest Mahoney,
  • Francisco Izquierdo,
  • Frederick A. Godley,
  • Garrett Nash,
  • Gary N. Mann,
  • George Salti,
  • Georgios Georgakis,
  • Gilbert Murimwa,
  • Giorgos Karakousis,
  • Hallbera Gudmundsdottir,
  • Hanlin L. Wang,
  • Hanna Sanoff,
  • Harveshp Mogal,
  • Hatem Halabi,
  • Hunter Witmer,
  • Ioannis Konstantinidis,
  • J. Randolph Hecht,
  • Jackson Baril,
  • Jacquelyne J. Gaddy,
  • James Campbell Cusack Jr,
  • Jane Wang,
  • Jason Foster,
  • Jason L. Hornick,
  • Javid Sadjadi,
  • Jeff Sussman,
  • Jeffrey M. Sutton,
  • Jennifer Keller,
  • Jeremy Davis,
  • Jeremy Sharib,
  • Jesus Esquivel,
  • Joanna Buchheit,
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  • John Hart,
  • John Kunstman,
  • John Paul Shen,
  • Jordan Cloyd,
  • Jose M. Pimiento,
  • Joseph Kim,
  • Joshua Winer,
  • Jula Veerapong,
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  • Kamran Idrees,
  • Katherine Bever,
  • Kevin Sullivan,
  • Kimberly Johung,
  • Kimberly Kopecky,
  • Kohei Shitara,
  • Konstantinos Chouliaras,
  • Kostas Votanopoulos,
  • Kristina A. Matkowskyj,
  • Kurt Schultz,
  • Laura Lambert,
  • Lauren Raymond,
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  • Leanne Brown,
  • Leopoldo Fernandez,
  • Lindy Davis,
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  • Madeline B. Torres,
  • Maheswari Senthil,
  • Manish Shah,
  • Marcovalerio Melis,
  • Marcello Deraco,
  • Maria Russell,
  • Marie Robert,
  • Mary Garland-Kledzik,
  • Mason Vierra,
  • Masoumeh Ghayouri,
  • Mautin Barry-Hundeyin,
  • Mazin Al-Kasspooles,
  • Mecker Moller,
  • Mehraneh D. Jafari,
  • Melanie Ongchin,
  • Michael Foote,
  • Michael D. Kluger,
  • Michael Wach,
  • Michael White,
  • Mikaël Soucisse,
  • Mike Gibson,
  • Mio Kitano,
  • Mohamed Adam,
  • Mohammad Haroon Asif Choudry,
  • Mohammed Suraju,
  • Mojgan Hosseini,
  • Monica Malec,
  • Mustafa Raoof,
  • Nabil Wasif,
  • Nadège Fackche,
  • Nader Hanna,
  • Nataliya Uboha,
  • Neal Bhutiani,
  • Nikoloas Dallas,
  • Niraj J. Gusani,
  • Oliver Eng,
  • Olivier Glehen,
  • Pathik Aravind,
  • Patricio Polanco,
  • Patrick Wagner,
  • Paul Helft,
  • Paul Sugarbaker,
  • Pompiliu Piso,
  • Prakash Pandalai,
  • Quan P. Ly,
  • Rachel Kim,
  • Rachyl Shanker,
  • Raed Al-Rajabi,
  • Rajiv Agarwal,
  • Randall Zuckerman,
  • Rebecca Wiatrek,
  • Ricardo Bello,
  • Richard Alexander,
  • Richard Berri,
  • Richard Hoehn,
  • Rifat Mannan,
  • Riom Kwakman,
  • Rita Akumuo,
  • Robert Barone,
  • Robert Sticca,
  • Rupen Shah,
  • Ryan Merkow,
  • Sabha Ganai,
  • Sam Georg e Pappas,
  • Samantha Ruff,
  • Sameer Patel,
  • Samer Naffouje,
  • Samuel Klempner,
  • Sanjay Bagaria,
  • Sara Daniel,
  • Sarah Wilkins,
  • Sarbajit Mukherjee,
  • Scott Sherman,
  • Sean Dineen,
  • Seth Concors,
  • Shannon Altpeter,
  • Sherif Abdel-Misih,
  • Stacey Stein,
  • Stephanie Greco,
  • Steven Maron,
  • Susan Campbell,
  • T. Clark Gamblin,
  • Taylor Jaraczewski,
  • Thinzar Lwin,
  • Thorvardur Halfdanarson,
  • Travis Grotz,
  • Ugwuji Maduekwe,
  • Umut Uqba Sarpel,Khan,
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  • Vignesh Vudatha,
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  • Yan Li

摘要

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.