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The INDEPSO-ISPSM Consensus on Peritoneal Malignancies: General Principles of Cytoreductive Surgery and Technical
Niharika Garach1, Aditi Bhatt2, Swapnil Patel3
1Department of Surgical Oncology, Specialty Surgical Oncology, Mumbai, India.
Purpose:
In this section of the INDEPSO-ISPSM consensus, we aimed to address some general principles and technical aspects of cytoreductive surgery (CRS) that could be broadly applied in all patients treated by CRS for peritoneal malignancies.
Methods:
The modified Delphi technique was used with two rounds of voting. Fifty-six out of 62 (90.2%) invited surgeons agreed to vote. There were 38 questions on two pain topics: quantitative prognostic indications, radiological and pathological evaluation and general principles of cytoreductive surgery. A consensus was reached if any of the options received 70% or more votes (> 90% = strong consensus).
Results:
In round 1, 52/56 (92.8%) panelists voted and in round 2, 51/56 (90.1%). A consensus was reached on 31/38 (81.5%) questions (strong consensus on 13/38-34.2%). The panel strongly recommended having a specialist pathologist, a thorough pathological evaluation of CRS specimens, routine recording of radiological peritoneal cancer index and resection of organs like the rectum and spleen when they are directly involved by tumour. The panel did not recommend major hepatectomies, total gastrectomy and pancreaticoduodenectomy as part of CRS when these are required to resect peritoneal disease and total pelvic exenteration with CRS. Perfusion of the thoracic cavity during HIPEC was recommended only when the pleura was involved. A consensus was also reached on two-stage surgeries, visceral and target-region resections. No consensus was reached on routine use of chest tubes, smoke evacuators and timing of preoperative imaging.
Conclusion:
A strong consensus was reached on some widely accepted practices amongst peritoneal oncologists as well as indications for visceral and target-region resections. These recommendations could directly be applied to clinical practice. This consensus points towards a need to standardize technical aspects of CRS by a larger international consensus amongst expert surgeons.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s13193-025-02240-9.
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