Rethinking How Surgeons Are Trained to Treat Peritoneal Surface Malignancies

At the Peritoneal Surface Oncology Group International (PSOGI) meeting in Barcelona this October, Alliance Board Member Dr. Vadim Gushchin presented a new perspective on how surgeons should be trained to care for patients with peritoneal surface malignancies (PSM)—a group of rare cancers that spread inside the abdominal cavity, titled "What is special about teaching and learning PSM surgery?".

PSMs are cancers that spread inside the abdominal cavity, forming many small or large tumor deposits on the lining of the abdomen (omentum) and on organs such as the stomach, intestines, liver, spleen, and diaphragm. Some types of cancers which may have peritoneal surface malignancies include:

• Appendix cancer / Pseudomyxoma Peritonei (PMP)

• Colorectal cancer that spreads to the peritoneum

• Ovarian and fallopian tube cancers

• Gastric cancer with peritoneal spread

• Peritoneal mesothelioma

  

  Dr. Vadim Gushchin presenting at PSOGI

  
  

These cancers are especially complex because no two patients’ disease looks the same. Even when two people start with the same cancer type, the pattern, thickness, and spread of tumor inside the abdomen can vary dramatically. Some patients have disease clustered in just a few areas, while others have widespread deposits woven across multiple organs. Because of this unpredictability, surgeons often cannot know the full extent of disease until they are already in the operating room. It may take several hours of careful exploration to determine whether it is safe and possible to remove all visible cancer.

This makes training very different from most other types of surgery. In many surgical specialties, doctors become experts by practicing the same operation repeatedly. But PSM surgeries are never the same twice, so repetition alone cannot prepare a surgeon. Instead, the key skill is learning how to navigate uncertainty and make real-time decisions such as:

• How aggressively to remove tumor while protecting quality of life

• When a complete tumor removal (cytoreduction) is possible—and when it is not

• How to adjust the surgical plan based on what is discovered during the procedure

Dr. Gushchin explained that to be successful, training programs must focus on building:

• Strong general surgical skills first (so surgeons are technically ready to adapt in real time)

• Hands-on mentorship from experienced PSM surgeons in real cases

• Comfort discussing uncertainty, rather than pretending there is always a clear answer

• True team-based care, involving anesthesia, critical care, nursing, radiology, and oncology. Because patients undergoing these surgeries require complex support before, during, and after the procedure.

Treating PSMs are not about mastering a single standardized technique—it is about learning how to think, assess situations that change moment to moment, and make decisions that balance safety, effectiveness, and the patient’s long-term well-being.

Dr. Gushchin’s leadership highlights the Alliance’s ongoing commitment to improving patient care not only by expanding access to treatment, but also by helping ensure that future surgeons are prepared to provide it with expertise, compassion, and careful judgment.