New Guidelines for Peritoneal Surface Malignancies Enhance Oncological Unity

In June 2025, significant advancements were made in the treatment of peritoneal surface malignancies with the publication of new guidelines co-authored by a diverse group of oncologists and medical professionals. These guidelines, a collaborative effort featuring contributions from trainees and experts across various disciplines, were jointly published in the prestigious journals, Cancer and Annals of Surgical Oncology. Dr. Kiran Turaga, MD, MPH, a leading figure in surgical oncology at Yale Cancer Center, emphasized the importance of these new guidelines in addressing the unique challenges faced by approximately 70,000 patients in the United States expected to develop peritoneal metastases annually.

Historically, the management of peritoneal surface malignancies has been fraught with difficulties due to the complex nature of these diseases, which often arise from gastrointestinal and gynecologic cancers. As Dr. Turaga noted, the imaging of peritoneal metastases is particularly challenging, leading to many patients being excluded from crucial clinical trials. The previous guidelines, established in 2018 under the Chicago consensus, aimed to improve care but did not significantly impact national practices, thus necessitating a fresh approach.

The newly adopted guidelines incorporate a comprehensive review process, including input from a wider array of stakeholders, such as pathologists and patient representatives. This collaborative approach aimed to unify oncologists and reduce the variability in treatment that often leads to suboptimal patient outcomes. Dr. Turaga explained that the guidelines strive to standardize terminology and treatment options across institutions, enhancing the likelihood of curative therapies and clinical trial participation.

One of the critical improvements in these guidelines is their methodological rigor. The new recommendations resulted from an extensive Delphi process, involving rapid reviews akin to systematic reviews for various diseases, which contrasts sharply with the less structured approach of the past. The involvement of trainees in drafting the guidelines is particularly noteworthy, as it empowers a new generation of oncologists to engage proactively with the evolving landscape of cancer treatment.

Despite the promising nature of these guidelines, challenges persist in their implementation. Dr. Turaga identified 'epistemic closure' among oncologists as a significant barrier, where entrenched beliefs about treatment modalities can hinder acceptance of new methodologies. Additionally, effective dissemination of the guidelines across oncology institutions remains a critical hurdle, compounded by the rigid policies of insurance companies regarding patient care.

Looking forward, Dr. Turaga expressed optimism regarding the future of peritoneal surface malignancy care. He highlighted that the enthusiasm and innovative ideas brought forth by surgical oncology fellows and trainees could drive meaningful change in this field. The commitment to fostering a collaborative environment among various specialties, including surgery, chemotherapy, and radiation therapy, is vital in progressing toward unified patient care strategies.

In conclusion, the newly established guidelines for managing peritoneal surface malignancies represent a significant step forward in oncological care. By addressing the historical challenges and embracing a collaborative approach, these guidelines aim to enhance treatment outcomes for thousands of patients facing these complex diseases. As the oncology community moves forward, the focus will remain on overcoming obstacles to implementation and fostering a culture of unity and shared goals in patient care.