TY - JOUR
T1 - Consensus guideline for the management of patients with appendiceal tumors, part 2
T2 - Appendiceal tumors with peritoneal involvement
AU - Peritoneal Surface Malignancies Consortium Group
AU - Godfrey, Elizabeth L.
AU - Mahoney, Forest
AU - Bansal, Varun V.
AU - Su, David G.
AU - Hanna, David N.
AU - Lopez-Ramirez, Felipe
AU - Baron, Ekaterina
AU - Turaga, Kiran K.
AU - Benson, Al B.
AU - Setia, Namrata
AU - Winer, Joshua H.
AU - Gunderson, Craig G.
AU - Shah, Rupen
AU - Magge, Deepa R.
AU - Solsky, Ian
AU - Eng, Cathy
AU - Eng, Oliver S.
AU - Shergill, Ardaman
AU - Shen, John Paul
AU - Misdraji, Joseph
AU - Foote, Michael B.
AU - Luo, Wenyi
AU - Hamed, Ahmed
AU - Khader, Adam
AU - Venook, Alan
AU - Tam, Alda
AU - Fisher, Alex
AU - Kim, Alex
AU - Loftus, Alexander
AU - Thomas, Alexander
AU - Gangi, Alexandra
AU - Greene, Alicia
AU - Greenbaum, Alissa
AU - Arrington, Amanda
AU - Abu Alfa, Amer K.
AU - Gleisner, Ana
AU - Kothari, Anai
AU - Govindarajan, Anand
AU - Holowatyj, Andreana N.
AU - Nikiforchin, Andrei
AU - Abreu, Andres
AU - Blakely, Andrew
AU - Łowy, Andrew
AU - Bellizzi, Andrew M.
AU - Dhiman, Ankit
AU - Villano, Anthony
AU - Bouchard-Fortier, Antoine
AU - Saeed, Anwaar
AU - Sardi, Armando
AU - Georgakis, Georgios
N1 - Publisher Copyright:
© 2025 American Cancer Society.
PY - 2025/7/1
Y1 - 2025/7/1
N2 - Background: Appendiceal tumors comprise a heterogeneous group of tumors that frequently disseminate to the peritoneum. Management of appendiceal tumors is lacking high-quality data given their rarity and heterogeneity. In general, appendiceal tumor treatment is extrapolated in part from colorectal cancer or pooled studies, without definitive evidence of disease-specific benefit. Many practices are controversial and vary widely between institutions. A national consensus update of best management practices for appendiceal malignancies was performed to better standardize care. Herein, the authors present recommendations for the management of appendiceal tumors with peritoneal involvement. Methods: As previously described, modified Delphi consensus was performed to update the previous 2018 Chicago Consensus guideline. Recommendations were supported by using rapid systematic reviews of key issues in surgical and systemic therapy. Key pathology concepts and recommendations were synthesized in collaboration with content experts. Results: A consensus-based pathway was generated for any type of non-neuroendocrine appendiceal tumor with peritoneal involvement. The first round of Delphi consensus included 138 participants, of whom 133 (96%) participated in the second round, and greater than 90% consensus was achieved for all pathway blocks. Key items included recommending evaluation for cytoreduction to most patients with low-grade peritoneal disease who are surgical candidates and to many patients with high-grade disease, as well as timing of systemic chemotherapy and surveillance protocols. Common pitfalls in pathologic classification and their clinical implications are also presented. Conclusions: These consensus recommendations provide guidance regarding the management of appendiceal tumors with peritoneal involvement, including a review of current evidence in the management of recurrent and unresectable disease.
AB - Background: Appendiceal tumors comprise a heterogeneous group of tumors that frequently disseminate to the peritoneum. Management of appendiceal tumors is lacking high-quality data given their rarity and heterogeneity. In general, appendiceal tumor treatment is extrapolated in part from colorectal cancer or pooled studies, without definitive evidence of disease-specific benefit. Many practices are controversial and vary widely between institutions. A national consensus update of best management practices for appendiceal malignancies was performed to better standardize care. Herein, the authors present recommendations for the management of appendiceal tumors with peritoneal involvement. Methods: As previously described, modified Delphi consensus was performed to update the previous 2018 Chicago Consensus guideline. Recommendations were supported by using rapid systematic reviews of key issues in surgical and systemic therapy. Key pathology concepts and recommendations were synthesized in collaboration with content experts. Results: A consensus-based pathway was generated for any type of non-neuroendocrine appendiceal tumor with peritoneal involvement. The first round of Delphi consensus included 138 participants, of whom 133 (96%) participated in the second round, and greater than 90% consensus was achieved for all pathway blocks. Key items included recommending evaluation for cytoreduction to most patients with low-grade peritoneal disease who are surgical candidates and to many patients with high-grade disease, as well as timing of systemic chemotherapy and surveillance protocols. Common pitfalls in pathologic classification and their clinical implications are also presented. Conclusions: These consensus recommendations provide guidance regarding the management of appendiceal tumors with peritoneal involvement, including a review of current evidence in the management of recurrent and unresectable disease.
KW - appendiceal malignancies
KW - cytoreductive surgical procedures, guidelines
KW - peritoneal neoplasms
KW - peritoneal surface malignancies
UR - https://www.scopus.com/pages/publications/105009658015
U2 - 10.1002/cncr.35874
DO - 10.1002/cncr.35874
M3 - Comment/debate
C2 - 40558065
AN - SCOPUS:105009658015
SN - 0008-543X
VL - 131
JO - Cancer
JF - Cancer
IS - 13
M1 - e35874
ER -