Guidelines 2000 for colon and rectal cancer surgery

Heidi Nelson, Nicholas Petrelli, Arthur Carlin, Jean Couture, James Fleshman, Jose Guillem, Brent Miedema, David Ota, Daniel Sargent

Research output: Contribution to journalArticle

964 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)583-596
Number of pages14
JournalJournal of the National Cancer Institute
Volume93
Issue number8
StatePublished - Apr 18 2001

Fingerprint

Rectal Neoplasms
Colonic Neoplasms
Guidelines
Colon
Lymph Node Excision
Rectum
National Cancer Institute (U.S.)
Colectomy
Touch
Ovariectomy
Practice Guidelines
Ligation
Neoplasms
Consensus
Neoplasm Metastasis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Nelson, H., Petrelli, N., Carlin, A., Couture, J., Fleshman, J., Guillem, J., ... Sargent, D. (2001). Guidelines 2000 for colon and rectal cancer surgery. Journal of the National Cancer Institute, 93(8), 583-596.

Guidelines 2000 for colon and rectal cancer surgery. / Nelson, Heidi; Petrelli, Nicholas; Carlin, Arthur; Couture, Jean; Fleshman, James; Guillem, Jose; Miedema, Brent; Ota, David; Sargent, Daniel.

In: Journal of the National Cancer Institute, Vol. 93, No. 8, 18.04.2001, p. 583-596.

Research output: Contribution to journalArticle

Nelson, H, Petrelli, N, Carlin, A, Couture, J, Fleshman, J, Guillem, J, Miedema, B, Ota, D & Sargent, D 2001, 'Guidelines 2000 for colon and rectal cancer surgery', Journal of the National Cancer Institute, vol. 93, no. 8, pp. 583-596.
Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J et al. Guidelines 2000 for colon and rectal cancer surgery. Journal of the National Cancer Institute. 2001 Apr 18;93(8):583-596.
Nelson, Heidi ; Petrelli, Nicholas ; Carlin, Arthur ; Couture, Jean ; Fleshman, James ; Guillem, Jose ; Miedema, Brent ; Ota, David ; Sargent, Daniel. / Guidelines 2000 for colon and rectal cancer surgery. In: Journal of the National Cancer Institute. 2001 ; Vol. 93, No. 8. pp. 583-596.
@article{51bdc21a233c43578aedf4a92e8914db,
title = "Guidelines 2000 for colon and rectal cancer surgery",
abstract = "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.",
author = "Heidi Nelson and Nicholas Petrelli and Arthur Carlin and Jean Couture and James Fleshman and Jose Guillem and Brent Miedema and David Ota and Daniel Sargent",
year = "2001",
month = "4",
day = "18",
language = "English (US)",
volume = "93",
pages = "583--596",
journal = "Journal of the National Cancer Institute",
issn = "0027-8874",
publisher = "Oxford University Press",
number = "8",

}

TY - JOUR

T1 - Guidelines 2000 for colon and rectal cancer surgery

AU - Nelson, Heidi

AU - Petrelli, Nicholas

AU - Carlin, Arthur

AU - Couture, Jean

AU - Fleshman, James

AU - Guillem, Jose

AU - Miedema, Brent

AU - Ota, David

AU - Sargent, Daniel

PY - 2001/4/18

Y1 - 2001/4/18

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0035906213&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035906213&partnerID=8YFLogxK

M3 - Article

VL - 93

SP - 583

EP - 596

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

SN - 0027-8874

IS - 8

ER -