Rectal Cancer Clinical Practice Guidelines in OncologyNCCN Categories of Evidence and ConsensusCategory 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus.Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus.Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement).Category 3: The recommendation is based on any level of evidence but reflects major disagreement.All recommendations are category 2A unless otherwise noted.Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.OverviewIn 2009 an estimated 40,870 new cases of rectal cancer will occur in the United States (23,580 cases in men; 17,290 cases in women). During the same year, an estimated 49,920 people will die from rectal and colon cancers.1 Although colorectal cancer is ranked as the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States, mortality from colorectal cancer has decreased during the past 30 years. This decrease may be due to earlier diagnosis through screening and better treatment modalities.The recommendations in these clinical practice guidelines are classified as category 2A except where noted, meaning that there is uniform NCCN consensus, based on lower-level evidence (including...

If the inline PDF is not rendering correctly, you can download the PDF file here.


  • 1

    JemalASiegelRWardE. Cancer statistics, 2009. CA Cancer J Clin2009;59:225229.

  • 2

    BonelliLMartinesHConioM. Family history of colorectal cancer as a risk factor for benign and malignant tumours of the large bowel. A case-control study. Int J Cancer1988;41:513517.

  • 3

    AhsanHNeugutAIGarbowskiGC. Family history of colorectal adenomatous polyps and increased risk for colorectal cancer. Ann Intern Med1998;128:900905.

  • 4

    GreeneFPageDFlemingIFritzA. AJCC Cancer Staging Manual. New York: Springer-Verlag; 2002.

  • 5

    ComptonCCGreeneFL. The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin2004;54:295308.

  • 6

    GreeneFLStewartAKNortonHJ. A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients. Ann Surg2002;236:416421; discussion 421.

  • 7

    ComptonCC. Updated protocol for the examination of specimens from patients with carcinomas of the colon and rectum, excluding carcinoid tumors, lymphomas, sarcomas, and tumors of the vermiform appendix: a basis for checklists. Cancer Committee. Arch Pathol Lab Med2000;124:10161025.

  • 8

    ComptonCC. Key issues in reporting common cancer specimens: problems in pathologic staging of colon cancer. Arch Pathol Lab Med2006;130:318324.

  • 9

    LaiLLFullerCDKachnicLAThomasCRJr. Can pelvic radiotherapy be omitted in select patients with rectal cancer?Semin Oncol2006;33(Suppl 11):S70–74.

  • 10

    NagtegaalIDMarijnenCAKranenbargEK. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol2002;26:350357.

  • 11

    WibeARendedalPRSvenssonE. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg2002;89:327334.

  • 12

    StocchiLNelsonHSargentDJ. Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report. J Clin Oncol2001;19:38953902.

  • 13

    Glynne-JonesRMawdsleySNovellJR. The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer: why we need a common language. Colorectal Dis2006;8:800807.

  • 14

    AdamIJMohamdeeMOMartinIG. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet1994;344:707711.

  • 15

    MawdsleySGlynne-JonesRGraingerJ. Can histopathologic assessment of circumferential margin after preoperative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for 3-year disease-free survival?Int J Radiat Oncol Biol Phys2005;63:745752.

  • 16

    NagtegaalIDQuirkeP. What is the role for the circumferential margin in the modern treatment of rectal cancer?J Clin Oncol2008;26:303312.

  • 17

    SarliLBaderGIuscoD. Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer2005;41:272279.

  • 18

    NewlandRCDentOFLyttleMN. Pathologic determinants of survival associated with colorectal cancer with lymph node metastases. A multivariate analysis of 579 patients. Cancer1994;73:20762082.

  • 19

    WongSLHongJHollenbeckBK. Hospital lymph node examination rates and survival after resection for colon cancer. JAMA2007;298:21492154.

  • 20

    TepperJEO’ConnellMJNiedzwieckiD. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol2001;19:157163.

  • 21

    PocardMPanisYMalassagneB. Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimens. Dis Colon Rectum1998;41:839845.

  • 22

    WichmannMWMullerCMeyerG. Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg2002;137:206210.

  • 23

    BaxterNNMorrisAMRothenbergerDATeppeJE. Impact of pre-operative radiation for rectal cancer on subsequent lymph node evaluation: population based analysis. Int J Rad Oncol Biol Phys2005;61:426431.

  • 24

    MeyersMOHollisDRMayerRJ. Ratio of metastatic to examined lymph nodes is a powerful predictor of overall survival in rectal cancer: an analysis of Intergroup 0114 [abstract]. J Clin Oncol2007;25(Suppl 1):Abstract 4008.

  • 25

    TurnerRRNoraDTTrochaSDBilchikAJ. Colorectal carcinoma nodal staging. Frequency and nature of cytokeratin-positive cells in sentinel and nonsentinel lymph nodes. Arch Pathol Lab Med2003;127:673679.

  • 26

    WoodTFNoraDTMortonDL. One hundred consecutive cases of sentinel node mapping in early colorectal carcinoma. Detection of micrometastasis. J Gastrointest Surg2002;6:322330.

  • 27

    NouraSYamamotoHMiyakeY. Immunohistochemical assessment of localization and frequency of micrometastases in lymph nodes of colorectal cancer. Clin Cancer Res2002;8:759767.

  • 28

    YasudaKAdachiYShiraishiN. Pattern of lymph node micrometastasis and prognosis of patients with colorectal cancer. Ann Surg Oncol2001;8:300304.

  • 29

    BraatAEOosterhuisJWMollFC. Sentinel node detection after preoperative short-course radiotherapy in rectal carcinoma is not reliable. Br J Surg2005;92:15331538.

  • 30

    BaselgaJRosenN. Determinants of RASistance to anti-epidermal growth factor receptor agents. J Clin Oncol2008;26:15821584.

  • 31

    AmadoRGWolfMPeetersM. Wild-type KRAS is required for panitumumab efficacy in patients with metastatic colorectal cancer. J Clin Oncol2008;26:16261634.

  • 32

    Khambata-FordSGarrettCRMeropolNJ. Expression of epiregulin and amphiregulin and K-ras mutation status predict disease control in metastatic colorectal cancer patients treated with cetuximab. J Clin Oncol2007;25:32303237.

  • 33

    De RoockWPiessevauxHDe SchutterJ. KRAS wild-type state predicts survival and is associated to early radiological response in metastatic colorectal cancer treated with cetuximab. Ann Oncol2008;19:508515.

  • 34

    PuntCJTolJRodenburgCJ. Randomized phase III study of capecitabine, oxaliplatin, and bevacizumab with or without cetuximab in advanced colorectal cancer, the CAIRO2 study of the Dutch Colorectal Cancer Group [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract LBA 4011.

  • 35

    BokemeyerCBondarenkoIMakhsonA. Fluorouracil, leucovorin, and oxaliplatin with and without cetuximab in the first-line treatment of metastatic colorectal cancer. J Clin Oncol2009;27:663771.

  • 36

    TejparSPeetersMHumbletY. Relationship of efficacy with KRAS status (wild type versus mutant) in patients with irinotecan-refractory metastatic colorectal cancer, treated with irinotecan and escalating doses of cetuximab: the EVEREST experience (preliminary data) [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract 4001.

  • 37

    Van CutsemEHenning-KohneCHitreE. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med2009; 36014:14081417.

  • 38

    LièvreABachetJBBoigeV. KRAS mutations as an independent prognostic factor in patients with advanced colorectal cancer treated with cetuximab. J Clin Oncol2008;26:374379.

  • 39

    KarapetisCSKhambata-FordSJonkerDJ. K-ras mutations and benefit from cetuximab in advanced colorectal cancer. N Engl J Med2008;359:17571765.

  • 40

    LievreABachetJBBoigeV. KRAS mutations as an independent prognostic factor in patients with advanced colorectal cancer treatment with cetuximab. J Clin Oncol2008;26:374379.

  • 41

    ArtaleSSartore-BianchiAVeroneseSM. Mutations in KRAS and BRAF in primary and matched metastatic sites of colorectal cancer. J Clin Oncol2008;26:42174219.

  • 42

    Etienne-GrimaldiMCFormentoJLFrancoualM. KRAS mutations in treatment outcome in colorectal cancer in patients receiving exclusive fluoropyrimidine. Clin Cancer Res2008;14:48304835.

  • 50

    NelsonHPetrelliNCarlinA. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst2001;93:583596.

  • 51

    KapiteijnEMarijnenCANagtegaalID. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med2001;345:638646.

  • 52

    SchoellhammerHFGregorianACSarkisyanGGPetrieBA. How important is rigid proctosigmoidoscopy in localizing rectal cancer. Am J Surg2008;186:904908.

  • 53

    BaxterNNGarcia-AguilarJ. Organ preservation for rectal cancer. J Clin Oncol2007;25:10141020.

  • 54

    WeiserMRLandmannRGWongWD. Surgical salvage of recurrent rectal cancer after transanal excision. Dis Colon Rectum2005;48:11691175.

  • 55

    WiigJNLarsenSGGierckskyKE. Operative treatment of locally recurrent rectal cancer. Recent Results Cancer Res2005;165:136147.

  • 56

    BartramCBrownG. Endorectal ultrasound and magnetic resonance imaging in rectal cancer staging. Gastroenterol Clin North Am2002;31:827839.

  • 57

    BipatSGlasASSlorsFJ. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology2004;232:773783.

  • 58

    KlessenCRogallaPTaupitzM. Local staging of rectal cancer: the current role of MRI. Eur Radiol2007;17:379389.

  • 59

    LahayeMJEngelenSMNelemansPJ. Imaging for predicting the risk factors—the circumferential resection margin and nodal disease—of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR2005;26:259268.

  • 60

    Beets-TanRGVliegenRFBeetsGL. Magnetic resonance imaging of rectal cancer: what radiation oncologists need to know. Front Radiat Ther Oncol2004;38:112.

  • 61

    GuillemJGCohenAM. Current issues in colorectal cancer surgery. Semin Oncol1999;26:505513.

  • 62

    YouYNBaxterNNStewartANelsonH. Is the increasing rate of local excision for stage I rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database. Ann Surg2007;245:726733.

  • 63

    LandmannRGWongWDHoepflJ. Limitations of early rectal cancer nodal staging may explain failure after local excision. Dis Colon Rectum2007;50:15201525.

  • 64

    NashGMWeiserMRGuillemJG. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum2009;52:577582.

  • 65

    JayneDGGuillouThorpeH. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol2007;25:30613068.

  • 66

    NgSSLeungKLLeeJF. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol2008;15:24182425.

  • 67

    WagmanLJ. Laparoscopic and open surgery for colorectal cancer: reaching equipoise?J Clin Oncol2007;25:29962998.

  • 68

    HealdRJHusbandEMRyallRD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?Br J Surg1982;69:613616.

  • 69

    ParfittJRDrimanDK. The total mesorectal excision specimen for rectal cancer: a review of its pathological assessment. J Clin Pathol2007;60:849855.

  • 70

    NagetgaalIDvan de VeldeCJHvan der WorpE. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol2002;20:17291734.

  • 71

    MarrRBirbeckKGarvicanJ. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg2005;242:7482.

  • 72

    PahlmanLBoheMCedermarkB. The Swedish rectal cancer registry. Br J Surg2007;94:12851292.

  • 73

    den DulkMPutterHColletteL. The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer2009;45:11751183.

  • 74

    SteupWHMoriyaYvan de veldeCJH. Patterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases. Eur J Cancer2002;38:911918.

  • 75

    SchlagPM. Surgical sphincter preservation in rectal cancer. Oncologist1996;1:288292.

  • 76

    WagmanRMinskyBDCohenAM. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up. Int J Radiat Oncol Biol Phys1998;42:5157.

  • 77

    SauerRBeckerHHohenbergerW. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med2004;351:17311740.

  • 78

    KachnicLA. Should preoperative or postoperative therapy be administered in the management of rectal cancer?Semin Oncol2006;33(Suppl 11):S6469.

  • 79

    MadoffRD. Chemoradiotherapy for rectal cancer—when, why, and how?N Engl J Med2004;351:17901792.

  • 80

    GuillemJGDiaz-GonzolezJAMinskyB. cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol2008;26:368373.

  • 81

    Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med1997;336:980987.

  • 82

    Colorectal Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet2001;358:12911304.

  • 83

    PeetersKCMJMarijnenCAMNagtegaalID. The TME trial after a median follow-up of 6 years. Ann Surg2007;246:693701.

  • 84

    Sebag-MontefioreDStephensRJSteeleR. Prooperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet2009;373:811820.

  • 85

    GerardJPConroyTBonnetainF. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol2006;24:46204625.

  • 86

    CeelenWPvan NieuwenhoveYFierensK. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer (review). Cochrane Database Syst Rev2009;CD006041.

  • 87

    Glynne-JonesRSebag-MontefioreD. Role of neoadjuvant chemotherapy in rectal cancer: interpretation of the EXPERT study. J Clin Oncol2006;24:46644665; author reply 4665–4666.

  • 88

    BossetJFCalaisGMineurL. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results—EORTC 22921. J Clin Oncol2005;23:56205627.

  • 89

    BossetJFColletteLCalaisG. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med2006;355:11141123.

  • 90

    ColletteLBossetJFden DulkM. Patients with curative resection of cT3-4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the EORTC Group. J Clin Oncol2007;25:43794386.

  • 91

    BujkoKKepkaLMichalskiWNowackiMP. Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol2006;80:412.

  • 92

    WongRKTandanVDe SilvaSFigueredoA. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev2007:CD002102.

  • 93

    PeetersKCvan de VeldeCJLeerJW. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol2005;23:61996206.

  • 94

    TepperJEO’ConnellMNiedzwieckiD. Adjuvant therapy in rectal cancer: analysis of stage, sex, and local control—final report of intergroup 0114. J Clin Oncol2002;20:17441750.

  • 95

    GundersonLLSargentDJTepperJE. Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J Clin Oncol2004;22:17851796.

  • 96

    JohalBSPhangPMcGahanC. Treatment patterns and outcomes of patients with pT3N0 rectal cancer in a population-based setting [abstract]. J Clin Oncol2007;25(Suppl 1):Abstract 4039.

  • 97

    SmalleySRBenedettiJKWilliamsonSK. Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol2006;24:35423547.

  • 98

    O’ConnellMJMartensonJAWieandHS. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med1994;331:502507.

  • 99

    AndreTBoniCNavarro. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC Trial. J Clin Oncol2009;27:31093116.

  • 100

    TwelvesCWongANowackiMP. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med2005;352:26962704.

  • 101

    HongTSRitterMATomeWAHarariPM. Intensity-modulated radiation therapy: emerging cancer treatment technology. Br J Cancer2005;92:18191824.

  • 102

    MeyerJCzitoBYinFFWillettC. Advanced radiation therapy technologies in the treatment of rectal and anal cancer: intensity-modulated photon therapy and proton therapy. Clin Colorectal Cancer2007;6:348356.

  • 103

    American College of Radiology. Practice Guideline for Intensity-modulated radiation therapy (IMRT) 2007; Available at: Accessed July 2009

  • 104

    ValentiVBalducciMTororetoF. Intraoperative radiotherapy: current thinking. Eur J Surg Oncol2002;28:180185.

  • 105

    HahnloserDHaddockMGNelsonH. Intraoperative radiotherapy in the multimodality approach to colorectal cancer. Surg Oncol Clin N Am2003;12:9931013.

  • 106

    WillettCGCzitoBGTylerDS. Intraoperative radiation therapy. J Clin Oncol2007;25:971977.

  • 107

    MooreHGGittlemanAEMinskyBD. Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum2004;47:279286.

  • 108

    Habr-GamaAPerezROProscurshimI. Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome?Int J Radiat Oncol Biol Phys2008;71:11811188.

  • 109

    TulchinskyHShmuellEGigerA. An interval > 7 weeks between neoadjuvant theapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol2008;15:26612667.

  • 110

    TranCLUdaniSHoltAArnellT. Evaluation of safety of increased time interval between chemoradiation and resection for rectal cancer. Am J Surg2006;192:873877.

  • 111

    WolmarkNWieandHSHyamsDM. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst2000;92:388396.

  • 112

    BensonABIII. New approaches to the adjuvant therapy of colon cancer. Oncologist2006;11:973980.

  • 113

    MinskyBDGuillemJG. Multidisciplinary management of resectable rectal cancer: new developments and controversies. Oncology (Williston Park)2008;22:14301437.

  • 114

    FakihM. Treating rectal cancer: key issues reconsidered. Oncology (Williston Park)2008;22:14441446.

  • 115

    BensonABIII. New approaches to assessing and treating early-stage colon and rectal cancers: cooperative group strategies for assessing optimal approaches in early-stage disease. Clin Cancer Res2007;13:6913s6920s.

  • 116

    SenguptaSTjandraJJ. Local excision of rectal cancer: what is the evidence?Dis Colon Rectum2001;44:13451361.

  • 117

    Garcia-AguilarJMellgrenASirivongsP. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg2000;231:345351.

  • 118

    WillettCGComptonCCShellitoPCEfirdJT. Selection factors for local excision or abdominoperineal resection of early stage rectal cancer. Cancer1994;73:27162720.

  • 119

    Van CutsemENordlingerBAdamR. Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer2006;42:22122221.

  • 120

    YooPSLopez-SolerRILongoWEChaCH. Liver resection for metastatic colorectal cancer in the age of neoadjuvant chemotherapy and bevacizumab. Clin Colorectal Cancer2006;6:202207.

  • 121

    KemenyN. Management of liver metastases from colorectal cancer. Oncology (Williston Park)2006;20:116111761179.

  • 122

    MuratoreAZorziDBouzariH. Asymptomatic colorectal cancer with un-resectable liver metastases: immediate colorectal resection or up-front systemic chemotherapy?Ann Surg Oncol2007;14:766770.

  • 123

    AlbertsSRHorvathWLSternfeldWC. Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: a North Central Cancer Treatment Group phase II study. J Clin Oncol2005;23:92439249.

  • 124

    FongYCohenAMFortnerJG. Liver resection for colorectal metastases. J Clin Oncol1997;15:938946.

  • 125

    TsaiMSuYHoM. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastases. Ann Surg Oncol2007;14:786794.

  • 126

    PoultsidesGAServaisELSaltzLB. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol2009;27:33793384.

  • 127

    FosterJH. Treatment of metastatic disease of the liver: a skeptic’s view. Semin Liver Dis1984;4:170179.

  • 128

    StanglRAltendorf-HofmannACharnleyRMScheeleJ. Factors influencing the natural history of colorectal liver metastases. Lancet1994;343:14051410.

  • 129

    VenookAP. The Kemeny article reviewed. Oncology2006;20:477484.

  • 130

    ChotiMASitzmannJVTiburiMF. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg2002;235:759766.

  • 131

    PawlikTMPoonRTAbdallaEK. Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg2005;140:450457; discussion 457–458.

  • 132

    CharnsangavejCClaryBFongY. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol2006;13:12611268.

  • 133

    VautheyJNZorziDPawlikTM. Making unresectable hepatic colorectal metastases resectable—does it work?Semin Oncol2005;32(Suppl 9):S118122.

  • 134

    PozzoCBassoMCassanoA. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol2004;15:933939.

  • 135

    Altendorf-HofmannAScheeleJ. A critical review of the major indicators of prognosis after resection of hepatic metastases from colorectal carcinoma. Surg Oncol Clin N Am2003;12:165192.

  • 136

    PawlikTMSchulickRDChotiMA. Expanding criteria for resectability of colorectal liver metastases. Oncologist2008;13:5164.

  • 137

    FolprechtGGrotheyAAlbertsS. Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates. Ann Oncol2005;16:13111319.

  • 138

    ReddySKPawlikTMZorziD. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol2007;14:34813491.

  • 139

    CoveyAMBrownKTJarnaginWR. Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases. Ann Surg2008;247:451455.

  • 140

    AdamRMillerRPitomboM. Two-stage hepatectomy approach for initially unresectable colorectal hepatic metastases. Surg Oncol Clin N Am2007;16:525536.

  • 141

    AbdallaEK. Commentary: radiofrequency ablation for colorectal liver metastases: do not blame the biology when it is the technology. Am J Surg2009;197:737739.

  • 142

    AbdallaEKVautheyJNEllisLM. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg2004;239:818825.

  • 143

    HurHKoYTMinBS. Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases. Am J Surg2009;197:728736.

  • 144

    GleisnerALChotiMAAssumpcaoL. Colorectal liver metastases: recurrence and survival following hepatic resectin, radiofrequency ablation, and combined resection-radiofrequency ablation. Arch Surg2008;143:12041212.

  • 145

    ReuterNPWoodallCEScogginsCR. Radiofrequency ablation vs. resection for hepatic colorectal metastasis: therapeutically equivalent?J Gastrointest Surg2009;13:486491.

  • 146

    LeonardGDBrennerBKemenyNE. Neoadjuvant chemotherapy before liver resection for patients with unresectable liver metastases from colorectal carcinoma. J Clin Oncol2005;23:20382048.

  • 147

    BenoistSBrouquetAPennaC. Complete response of colorectal liver metastases after chemotherapy: does it mean cure?J Clin Oncol2006;24:39393945.

  • 148

    BilchikAJPostonGCurleySA. Neoadjuvant chemotherapy for metastatic colon cancer: a cautionary note. J Clin Oncol2005;23:90739078.

  • 149

    AdamRAvisarEAricheA. Five-year survival following hepatic resecton after neoadjuvant therapy for nonresectable colorectal cancer. Ann Surg Oncol2001;8:347353.

  • 150

    RivoireMDe CianFMeeusP. Combination of neoadjuvant chemotherapy with cryotherapy and surgical resection for the treatment of unresectable liver metastases from colorectal carcinoma. Cancer2002;95:22832292.

  • 151

    VautheyJNPawlikTMRiberoD. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol2006;24:20652072.

  • 152

    PawlikTMOlinoKGleisnerAL. Preoperative chemotheapy for colorectal liver metastases: impact on hepatic histology and postoperative outcome. J Gastrointest Surg2007;11:860888.

  • 153

    PawlikTMScogginsCRZorziD. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg2005;241:715722.

  • 154

    EliasDLiberaleGVernereyD. Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol2005;12:900909.

  • 155

    FongYSaloJ. Surgical therapy of hepatic colorectal metastasis. Semin Oncol1999;26:514523.

  • 156

    AdamRDelvartVPascalG. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg2004;240:644657.

  • 157

    DelaunoitTAlbertsSRSargentDJ. Chemotherapy permits resection of metastatic colorectal cancer: experience from Intergroup N9741. Ann Oncol2005;16:425429.

  • 158

    NordlingerBSorbyeHGlimeliusB. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomized controlled trial. Lancet2008;37:10071016.

  • 159

    TanBRZubalBHawkinsw. Preoperative FOLFOX plus cetuximab or panitumumab therapy for patients with potentially resectable hepatic colorectal metastases [abstract]. Prestented at the 2009 ASCO Gastrointestinal Cancers Symposium; January 15–17, 2009; San Francisco, California. Abstract 497.

  • 160

    FolprechtGGruenbergerTHartmannJT. Cetuximab plus FOLFOX6 or cetuximab plus FOLFIRI as neoadjuvant treatment of nonresectable colorectal liver metastases: A randomized multicenter study (CELIM-study) [abstract]. Presented at the 2009 ASCO Gastrointestinal Cancers Symposium; January 15–17 2009; San Francisco, California. Abstract 296.

  • 161

    SouglakosJAndroulakisNSyrigosK. FOLFOXIRI vs FOLFIRI as first-line treatment in metastatic colorectal cancer: a multicentre randomised phase III trial from the Hellenic Oncology Research Group. Br J Cancer2006;94:798805.

  • 162

    FalconeARicciSBrunettiI. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol2007;25:16701676.

  • 163

    ScappaticciFAFehrenbacherLCartwrightT. Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab. J Surg Oncol2005;91:173180.

  • 164

    Package Insert. Bevacizumab. South San Francisco, CAGenentech, Inc.October2006.

  • 165

    GruenbergerBTamandlDSchuellerJ. Bevacizumab, capecitabine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. J Clin Oncol2008;26:18301835.

  • 166

    ReddySKMorseMAHurwitzHI. Addition of bevacizumab to irinotecan- and oxaliplatin-based preoperative chemotherapy regimens does not increase morbidity after resection of colorectal liver metastases. J Am Coll Surg2008;206:96106.

  • 167

    LeeWSYunSHChunHK. Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival. Int J Colorectal Dis2007;22:699704.

  • 168

    HeadrickJRMillerDLNagorneyDM. Surgical treatment of hepatic and pulmonary metastases from colon cancer. Ann Thorac Surg2001;71:975979; discussion 979–980.

  • 169

    KemenyN. Management of liver metastases from colorectal cancer. Oncology (Williston Park)2006;20:116111761179.

  • 170

    KemenyNHuangYCohenAM. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med1999;341:20392048.

  • 171

    KemenyNEGonenM. Hepatic arterial infusion after liver resection. N Engl J Med2005;352:7:734735.

  • 172

    MulcahyMFLewandowskiRJIbrahimSM. Radioembolization of colorectal hepatic metastases using yttrium-90 microspheres. Cancer2009;115:18491858.

  • 173

    HongKMcBrideJDGeorgiadesCS. Salvage therapy for liver-dominant colorectal metastatic adenocarcinoma: comparison between transcatheter arterial chemoembolization versus yttrium-90 radioembolization. J Vasc Interv Radiol2009;20:360367.

  • 174

    KatzAWCarey-SampsonMMuhsAG. Hypofractionated stereotactic body radiation therapy (SBRT) for patients with limited hepatic metastases. Int J Radiat Oncol Biol Phys2007;67:793798.

  • 175

    YuT-KBhosalePRCraneCH. Patterns of locoregional recurrence after surgery and radiotherapy or chemoradiation for rectal cancer. Int J Rad Oncol Biol Phys2008;71:11751180.

  • 176

    LowyAMRichTASkibberJM. Preoperative infusional chemoradiation, selective intraoperative radiation, and resection for locally advanced pelvic recurrence of colorectal adenocarcinoma. Ann Surg1996;223:177185.

  • 177

    HoffmanJPRileyLCarpNZLitwinS. Isolated locally recurrent rectal cancer: a review of incidence, presentation, and management. Semin Oncol1993;20:506519.

  • 178

    BartlettDLBerlinJLauwersGY. Chemotherapy and regional therapy of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol2006;13:12841292.

  • 179

    PelosiEDeandreisD. The role of 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET) in the management of patients with colorectal cancer. Eur J Surg Oncol2007;33:16.

  • 180

    DresenRCGosensMJMartijnH. Radical resection after IORT-containing multimodality treatment is the most important determinant of outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol2008;15:19371947.

  • 181

    YanTDBlackDSavadyRSugarbakerPH. Systemic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol2006;24:40114019.

  • 182

    EsquivelJSticcaRSugarbakerP. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol2007;14:128133.

  • 199

    SprangersMAGTaalBGAaronsonNK. Quality of life in colorectal cancer: stoma vs. nonstoma patients. Dis Colon Rectum1995;38:361369.

  • 200

    LangeMMMassCPMarijnenCAM. Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Cancer2008;95:10201028.

  • 201

    LangeMMMassCPMarijnenCAM. Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer2009;45:15781588.

  • 202

    DeSnooLFaithfullS. A qualitative study of anterior resection syndrome: the experiences of cancer survivors who have undergone resection surgery. Eur J Cancer Care2006;15:244251.

  • 203

    BaxterNNHabermannEBTepperJE. Risk of pelvic fractures in older women following pelvic irradiation. JAMA2005;294:25872593.

  • 204

    DenlingerCSBarsevickAM. The Challenges of Colorectal Cancer Survivorship. J Natl Cancer Netw2009;7:in press.

  • 205

    DignamJLPoliteBNYothersG. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst2006;98:16471654.

  • 206

    MeyerhardtJAHeseltineDNiedzwieckiD. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol2006;24:35353541.

  • 207

    MeyerhardtJANiedzwieckiDHollisD. Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA2007;298:754764.

Article Information


Google Scholar

Related Articles


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 36 36 22
PDF Downloads 15 15 12
EPUB Downloads 0 0 0