The INDEPSO-ISPSM Consensus on Peritoneal Malignancies: General Principles of Cytoreductive Surgery and Technical Considerations

Niharika Garach; Aditi Bhatt; Swapnil Patel; Suryanarayana V S Deo; Arvind Guru; Rohit Kumar; Prasanth Penumadu; Somashekhar Sp; Vivek Sukumar; Deepti Mishra

doi:10.1007/s13193-025-02240-9

The INDEPSO-ISPSM Consensus on Peritoneal Malignancies: General Principles of Cytoreductive Surgery and Technical Considerations

Indian J Surg Oncol. 2025 Dec;16(6):1675-1695. doi: 10.1007/s13193-025-02240-9. Epub 2025 Mar 17.

Authors

Affiliations

¹ Department of Surgical Oncology, Specialty Surgical Oncology, Mumbai, India.
² Department of Surgical Oncology, Shalby Cancer Research Institute, Ahmedabad, India.
³ Department of Surgical Oncology, Upkar Hospital and Cancer Institute, Varanasi, India.
⁴ Department of Surgical Oncology, Apollo Hospital, New Delhi, India.
⁵ Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Center, Chandigarh, India.
⁶ Department of Surgical Oncology, Aster International Institute of Oncology, Bangalore, India.
⁷ Department of Shri Venkateshwara Cancer Institute, Tirupati, India.
⁸ Department of Surgical Oncology, Thangam Cancer Center, 54, Dr Sankaran Road, Namakkal, Tamil Nadu India.

PMID: 41415793
PMCID: PMC12708475 (available on 2026-12-01)
DOI: 10.1007/s13193-025-02240-9

Abstract

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.

Keywords: Cytoreductive surgery; INDEPSO-ISPSM consensus; Tumour.

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