© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 8, 583-596,
April 18, 2001
© 2001 Oxford University Press
SPECIAL ARTICLE |
Guidelines 2000 for Colon and Rectal Cancer Surgery
Affiliations of authors: H. Nelson, D. Sargent, Mayo Clinic, Rochester, MN; N. Petrelli, Roswell Park Cancer Institute, Buffalo, NY; A. Carlin, Wayne State University, Detroit, MI; J. Couture, Mount Sinai Hospital, Toronto, ON, Canada; J. Fleshman, Barnes-Jewish Hospital, St. Louis, MO; J. Guillem, Memorial Sloan-Kettering Cancer Center, New York, NY; B. Miedema, University of Missouri, Columbia; D. Ota, Ellis Fischel Cancer Center, Columbia, MO. (These authors make up the Writing Committee on behalf of the Expert Panel. All members of the Expert Panel and their institutional and Cancer Cooperative Group affiliations are listed in "Appendix 1.")
Correspondence to: Heidi Nelson, M.D., Mayo Clinic, 200 First St., S.W., Rochester, MN 55905 (e-mail: nelsonh{at}mayo.edu).
Background: Oncologic resection techniques affect outcome for colon cancer and rectal cancer, but standardized guidelines have not been adopted. The National Cancer Institute sponsored a panel of experts to systematically review current literature and to draft guidelines that provide uniform definitions, principles, and practices. Methods: Methods were similar to those described by the American Society of Clinical Oncology in developing practice guidelines. Experts representing oncology and surgery met to review current literature on oncologic resection techniques for level of evidence (I–V, where I is the best evidence and V is the least compelling) and grade of recommendation (A–D, where A is based on the best evidence and D is based on the weakest evidence). Initial guidelines were drafted, reviewed, and accepted by consensus. Results: For the following seven factors, the level of evidence was II, III, or IV, and the findings were generally consistent (grade B): anatomic definition of colon versus rectum, tumor–node–metastasis staging, radial margins, adjuvant R0 stage, inadvertent rectal perforation, distal and proximal rectal margins, and en bloc resection of adherent tumors. For another seven factors, the level of evidence was II, III, or IV, but findings were inconsistent (grade C): laparoscopic colectomy; colon lymphadenectomy; level of proximal vessel ligation, mesorectal excision, and extended lateral pelvic lymph node dissection (all three for rectal cancer); no-touch technique; and bowel washout. For the other four factors, there was little or no systematic empirical evidence (grade D): abdominal exploration, oophorectomy, extent of colon resection, and total length of rectum resected. Conclusions: The panel reports surgical guidelines and definitions based on the best available evidence. The availability of more standardized information in the future should allow for more grade A recommendations.
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