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An update of the 2018 Chicago consensus guidelines was conducted with a modified Delphi technique, which encompassed two rounds of voting. The levels of agreement for various pathway blocks were assessed, and key systemic therapy concepts were summarized by content experts. Supporting evidence was evaluated via a rapid literature review. Overall, the level of evidence for the management of PM in this disease was universally low. In total, 107 participants responded in the first round, with 88 of 107 (82%) participating in the second round. Strong consensus (&gt;90%) was achieved in five of seven (71%) and seven of seven (100%) blocks in rounds 1 and 2, respectively. A multidisciplinary approach including psychosocial and wellness assessments received a strong positive recommendation. Management of NENs with PM was organized according to disease grade and symptom profiles. In grade 1 and 2 well\u2010differentiated NENs, cytoreductive surgery received strong support (&gt;95%) after the management of functional syndromes (if present). For grade 3 well\u2010differentiated NENs, systemic therapy is the primary recommendation, with surgical resection considered in select cases. Given the limited evidence, the consensus\u2010driven clinical pathway offers vital clinical guidance for the management of NENs with PM. The need for high\u2010quality evidence remains critical to the field.<\/jats:p>","DOI":"10.1002\/cncr.35871","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T09:00:27Z","timestamp":1750842027000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Consensus guideline for the management of peritoneal metastases from neuroendocrine neoplasms"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8693-612X","authenticated-orcid":false,"given":"David G.","family":"Su","sequence":"first","affiliation":[{"name":"Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3940-4064","authenticated-orcid":false,"given":"Leanne M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9973-0884","authenticated-orcid":false,"given":"Varun V.","family":"Bansal","sequence":"additional","affiliation":[{"name":"Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baylee","family":"Bakkila","sequence":"additional","affiliation":[{"name":"Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seth J.","family":"Concors","sequence":"additional","affiliation":[{"name":"Emory University  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8541-586X","authenticated-orcid":false,"given":"Kiran K.","family":"Turaga","sequence":"additional","affiliation":[{"name":"Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Gunderson","sequence":"additional","affiliation":[{"name":"Yale School of Medicine  New Haven Connecticut USA"},{"name":"Veterans Affairs Connecticut Healthcare System  West Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Bergsland","sequence":"additional","affiliation":[{"name":"University of California San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan R.","family":"Strosberg","sequence":"additional","affiliation":[{"name":"Moffitt Cancer Center  Tampa Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thorvardur R.","family":"Halfdanarson","sequence":"additional","affiliation":[{"name":"Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C.","family":"Metz","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John W.","family":"Kunstman","sequence":"additional","affiliation":[{"name":"Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela L.","family":"Kunz","sequence":"additional","affiliation":[{"name":"Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Gangi","sequence":"additional","affiliation":[{"name":"Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Peritoneal Surface Malignancies Consortium Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12022\u2010022\u201009708\u20102"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jne.13264"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2022.100510"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2020.03.030"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000503144"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010016\u20105734\u2010x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010020\u201008321\u2010z"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010020\u201008317\u20109"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32827"},{"key":"e_1_2_10_11_1","unstructured":"BrownL SuD CraigG TuragaK.The Utility of Cytoreductive Surgery and Medical Management of Neuroendocrine Neoplasms With Peritoneal Dissemination: A Rapid Review. 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