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Al B. Benson III, J. Pablo Arnoletti, Tanios Bekaii-Saab, Emily Chan, Yi-Jen Chen, Michael A. Choti, Harry S. Cooper, Raza A. Dilawari, Paul F. Engstrom, Peter C. Enzinger, James W. Fleshman Jr., Charles S. Fuchs, Jean L. Grem, James A. Knol, Lucille A. Leong, Edward Lin, Kilian Salerno May, Mary F. Mulcahy, Kate Murphy, Eric Rohren, David P. Ryan, Leonard Saltz, Sunil Sharma, David Shibata, John M. Skibber, William Small Jr., Constantinos T. Sofocleous, Alan P. Venook and Christopher Willett

have undergone resection of liver metastases 150 , 153 Therefore, decisions relating to patient suitability, or potential suitability, and subsequent selection for metastatic colorectal surgery are critical junctures in the management of metastatic

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Paul F. Engstrom, Juan Pablo Arnoletti, Al B. Benson III, Yi-Jen Chen, Michael A. Choti, Harry S. Cooper, Anne Covey, Raza A. Dilawari, Dayna S. Early, Peter C. Enzinger, Marwan G. Fakih, James Fleshman Jr., Charles Fuchs, Jean L. Grem, Krystyna Kiel, James A. Knol, Lucille A. Leong, Edward Lin, Mary F. Mulcahy, Sujata Rao, David P. Ryan, Leonard Saltz, David Shibata, John M. Skibber, Constantinos Sofocleous, James Thomas, Alan P. Venook and Christopher Willett

Colon 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.OverviewColorectal cancer is the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States. In 2009, an estimated 106,100 new cases of colon and 40,870 cases of rectal cancer will occur. During the same year, it is estimated that 49,920 people will die from colon and rectal cancer.1 Despite these statistics, mortality from colon cancer has decreased slightly over the past 30 years, possibly due to earlier diagnosis through screening and better treatment modalities.This manuscript summarizes the NCCN Clinical Practice Guidelines in Oncology for managing colon cancer. The guidelines begin with clinical presentation to the primary care physician or gastroenterologist and address diagnosis, pathologic staging, surgical management, adjuvant treatment, management of recurrent and metastatic disease, and patient surveillance. When reviewing these guidelines, clinicians should be aware of...
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Paul F. Engstrom, Juan Pablo Arnoletti, Al B. Benson III, Yi-Jen Chen, Michael A. Choti, Harry S. Cooper, Anne Covey, Raza A. Dilawari, Dayna S. Early, Peter C. Enzinger, Marwan G. Fakih, James Fleshman Jr., Charles Fuchs, Jean L. Grem, Krystyna Kiel, James A. Knol, Lucille A. Leong, Edward Lin, Mary F. Mulcahy, Sujata Rao, David P. Ryan, Leonard Saltz, David Shibata, John M. Skibber, Constantinos Sofocleous, James Thomas, Alan P. Venook and Christopher Willett

Rectal Cancer Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 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. Overview In 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...
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Fikri İçli, Hakan Akbulut, Shouki Bazarbashi, Mehmet Ayhan Kuzu, Mohandas K. Mallath, Kakil Ibrahim Rasul, Scott Strong, Aamir Ali Syed, Faruk Zorlu and Paul F. Engstrom

colorectal surgery and TME, and the surgeries should occur at centers conducting more than 50 surgeries per year. Rationale The surgeon is an independent factor for outcome in colorectal surgery. The outcome was also related to surgical caseload and

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Daniëlle D. Huijts, Julia T. van Groningen, Onno R. Guicherit, Jan Willem T. Dekker, Leti van Bodegom-Vos, Esther Bastiaannet, Johannes A. Govaert, Michel W. Wouters and Perla J. Marang-van de Mheen

indications that these risks might be higher in surgeries performed during the weekend compared with weekdays: the so-called weekend effect. To date, a small number of studies have investigated the weekend effect in colorectal surgery. 3 – 8 However, these

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Mark Bloomston, Henry Kaufman, John Winston, Mark Arnold and Edward Martin

-assisted sigmoid colectomy and low anterior resection . Dis Colon Rectum 1994 ; 37 : 829 – 833 . 48 Puente I Sosa JL Sleeman D . Laparoscopic assisted colorectal surgery . J Laparoendosc Surg 1994 ; 4 : 1 – 7 . 49 Zucker KA Pitcher DE

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Daniëlle D. Huijts, Onno R. Guicherit, Jan Willem T. Dekker, Julia T. van Groningen, Leti van Bodegom-Vos, Esther Bastiaannet, Johannes A. Govaert, Michel W. Wouters and Perla J. Marang-van de Mheen

are indications that these adverse events might be different depending on the days on which the elective surgery is performed. 4 A recent study analyzing elective high-risk surgeries, including colorectal surgery, clearly observed a trend across

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Michelle E. Melisko and Joseph B. Narus

surgery can cause erectile dysfunction and impotence, and breast and colorectal surgeries may impact body image and self-esteem, explained Dr. Melisko, who also is a member of the NCCN Survivorship Panel. “Chemotherapy can affect sexual function in some

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Armin Shahrokni, Bella Marie Vishnevsky, Brian Jang, Saman Sarraf, Koshy Alexander, Soo Jung Kim, Robert Downey, Anoushka Afonso and Beatriz Korc-Grodzicki

colorectal surgery, ASA classification was not associated with postoperative complications. 5 Another study of 460 patients with cancer with a mean age of 76.9 years who underwent breast (47%), gastrointestinal (31%), or genitourinary surgery (15%) found

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Melissa Magrath, Edward Yang, Chul Ahn, Christian A. Mayorga, Purva Gopal, Caitlin C. Murphy, Samir Gupta, Deepak Agrawal, Ethan A. Halm, Eric K. Borton, Celette Sugg Skinner and Amit G. Singal

Southwestern Medical Center gastroenterology faculty with or without gastroenterology fellows, UT Southwestern Medical Center colorectal surgery faculty, or Parkland-employed gastroenterology faculty. For any patients with polypectomy, the endoscopist makes