The Chicago Consensus on peritoneal surface malignancies: Palliative care considerations

Abstract

The Chicago Consensus Working Group provides multidisciplinary recommendations for palliative care specifically related to peritoneal surface malignancies. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, gynecologic oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. Cancer 2020;126:2571-2576.Octreotide is a synthetic peptide mimicking the natural effects of somatostatin, thereby reducing gastrointestinal secretions and gastrointestinal motility. In multiple studies, octreotide has been demonstrated to reduce vomiting episodes and gastrointestinal symptoms. 17,18 In addition, quality-of-life scores have improved with the use of octreotide in nonrandomized clinical studies. 19,20 When compared with anticholinergic therapies,

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

“…78 Current recommendations align with the 2018 Chicago Consensus Guideline, suggesting consideration of parenteral nutrition in patients eligible for standard chemotherapy, possessing satisfactory performance status (ECOG =< 2 / KPS > 50%), and predicted survival of at least two months. 27 Social support and psychological preparedness should be evaluated before initiating parenteral nutrition, as it is a demanding course of treatment. Cytoreduction with or without intraperitoneal chemotherapy may be considered for surgical candidates, whereas hospice evaluation is recommended for individuals unlikely to benefit from aggressive interventions.…”

“…The current effort represents a substantial advancement over the Chicago Consensus Guidelines 2018 as it establishes a formal pathway with supporting evidence for procedural interventions tailored to patients with peritoneal carcinomatosis. 27 Over 95% consensus was achieved across all six blocks after two rounds of review by a multidisciplinary group. This methodology aims to provide clarity regarding clinical management despite issues highlighted in prior reviews surrounding the heterogeneity and quality of available evidence.…”

“…26 However, a formal pathway for the management of MGIO was lacking. 27 In this iteration, a pathway for MGIO management emerged through a modified Delphi consensus with two rounds of voting. Experts rated their agreement levels on a five-point Likert scale via a Qualtrics questionnaire.…”

Current Trends in Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Disease from Appendiceal and Colorectal Malignancies

“…Furthermore, because complete cytoreduction is not feasible in these patients, laparoscopic HIPEC is a reasonable approach with less associated morbidity [ 83 , 137 , 138 , 139 , 140 , 141 , 142 ]. Indeed, the Chicago Consensus Working Group now recommends laparoscopic HIPEC for the management of malignant ascites in patients who are not candidates for curative-intent CRS/HIPEC [ 143 ].…”

Evaluation of efficacy and safety for compound kushen injection combined with intraperitoneal chemotherapy for patients with malignant ascites: A systematic review and meta-analysis

“…The underlying diagnosis is associated with cancer in almost 10% of the patients with ascites, and ascites is the only manifestation in some cancer patients. (Chicago Consensus Working, 2020). MA is common in gynecological malignancies and gastrointestinal malignancies.…”