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These guidelines describe the results of a national consensus addressing the management of CRC with peritoneal metastases (CRC\u2010PM). An update of the 2018 Chicago consensus guidelines was conducted with a modified Delphi technique. Two rounds of voting were performed to assess agreement levels on two clinical management pathways regarding synchronous and metachronous CRC\u2010PM. Supporting evidence was evaluated via rapid literature reviews. The overall level of evidence was low in the existing literature. Of 145 participants in the first round, 136 (96.8%) responded in the second round. Over 90% consensus was achieved in most pathway blocks. For both pathways, early referral to a peritoneal surface malignancy center should be made for patients with CRC\u2010PM. For the synchronous pathway, upfront cytoreductive surgery was deemphasized in favor of systemic therapy. For the metachronous pathway, risk stratification via clinical and pathological features was revised. For both pathways, surveillance strategies were added, including only a weak recommendation for circulating tumor DNA testing, given limited evidence of its utility in detecting and monitoring PM. The consensus\u2010driven clinical pathways provide valuable guidance for the management of CRC\u2010PM. There remains a need for high\u2010quality evidence and prospective multicenter trials in this domain.<\/jats:p>","DOI":"10.1002\/cncr.35869","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T09:01:30Z","timestamp":1750842090000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Consensus guideline for the management of colorectal cancer with peritoneal metastases"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3548-3420","authenticated-orcid":false,"given":"Kurt S.","family":"Schultz","sequence":"first","affiliation":[{"name":"Department of Surgery Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9973-0884","authenticated-orcid":false,"given":"Varun V.","family":"Bansal","sequence":"additional","affiliation":[{"name":"Department of Surgery Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"Wach","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6288-2788","authenticated-orcid":false,"given":"Neal","family":"Bhutiani","sequence":"additional","affiliation":[{"name":"Department of Colon and Rectal Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4984-8064","authenticated-orcid":false,"suffix":"IV","given":"Frederick A.","family":"Godley","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Chicago Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3705-3993","authenticated-orcid":false,"given":"Jaeyun (Jane)","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Talha","family":"Waheed","sequence":"additional","affiliation":[{"name":"Department of Surgery City of Hope National Medical Center  Duarte California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0791-4193","authenticated-orcid":false,"given":"Joanna T.","family":"Buchheit","sequence":"additional","affiliation":[{"name":"Department of Surgery Penn State College of Medicine  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Papai","sequence":"additional","affiliation":[{"name":"Department of Surgery Lewis Katz School of Medicine Temple University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Vermont  Burlington Vermont USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E.","family":"Schleimer","sequence":"additional","affiliation":[{"name":"Department of Surgery Columbia University Irving Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8693-612X","authenticated-orcid":false,"given":"David G.","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Surgery Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8541-586X","authenticated-orcid":false,"given":"Kiran K.","family":"Turaga","sequence":"additional","affiliation":[{"name":"Department of Surgery Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig G.","family":"Gunderson","sequence":"additional","affiliation":[{"name":"Department of Medicine Yale School of Medicine  New Haven Connecticut USA"},{"name":"Veterans Affairs Connecticut Healthcare System  West Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"White","sequence":"additional","affiliation":[{"name":"Department of Colon and Rectal Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhineet","family":"Uppal","sequence":"additional","affiliation":[{"name":"Department of Colon and Rectal Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1311-4173","authenticated-orcid":false,"given":"Kanwal P. 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