Costas-Chavarri Ainhoa, Nandakumar Govind, Temin Sarah, Lopes Gilberto, Cervantes Andres, Cruz Correa Marcia, Engineer Rena, Hamashima Chisato, Ho Gwo Fuang, Huitzil Fidel David, Malekzadeh Moghani Mona, Sharara Ala I, Stern Mariana C, Teh Catherine, Vázquez Manjarrez Sara E, Verjee Azmina, Yantiss Rhonda, Shah Manish A
Rwanda Military Hospital, Kigali, Rwanda.
Columbia Asia Hospitals, Bangalore, India.
J Glob Oncol. 2019 Feb;5:1-19. doi: 10.1200/JGO.18.00214.
To provide resource-stratified, evidence-based recommendations on the treatment and follow-up of patients with early-stage colorectal cancer.
ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus process with additional experts for one round of formal ratings.
Existing sets of guidelines from 12 guideline developers were identified and reviewed; adapted recommendations from six guidelines form the evidence base and provide evidence to inform the formal consensus process, which resulted in agreement of 75% or more on all recommendations.
For nonmaximal settings, the recommended treatments for colon cancer stages nonobstructing, I-IIA: in basic and limited, open resection; in enhanced, adequately trained surgeons and laparoscopic or minimally invasive surgery, unless contraindicated. Treatments for IIB-IIC: in basic and limited, open en bloc resection following standard oncologic principles, if not possible, transfer to higher-level facility; in emergency, limit to life-saving procedures; in enhanced, laparoscopic en bloc resection, if not possible, then open. Treatments for obstructing, IIB-IIC: in basic, resection and/or diversion; in limited or enhanced, emergency surgical resection. Treatment for IIB-IIC with left-sided: in enhanced, may place colonic stent. Treatment for T4N0/T3N0 high-risk features or stage II high-risk obstructing: in enhanced, may offer adjuvant chemotherapy. Treatment for rectal cancer cT1N0 and cT2n0: in basic, limited, or enhanced, total mesorectal excision principles. Treatment for cT3n0: in basic and limited, total mesorectal excision, if not, diversion. Treatment for high-risk patients who did not receive neoadjuvant chemotherapy: in basic, limited, or enhanced, may offer adjuvant therapy. Treatment for resectable cT3N0 rectal cancer: in enhanced, base neoadjuvant chemotherapy on preoperative factors. For post-treatment surveillance, a combination of medical history, physical examination, carcinoembryonic antigen testing, imaging, and endoscopy is performed. Frequency depends on setting. Maximal setting recommendations are in the guideline. Additional information can be found at www.asco.org/resource-stratified-guidelines .
It is the view of the American Society of Clinical Oncology that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guidelines are intended to complement but not replace local guidelines.
提供基于资源分层、循证的早期结直肠癌患者治疗及随访建议。
美国临床肿瘤学会召集了一个多学科、跨国专家小组，该小组审查了现有指南，并采用改良的ADAPTE流程以及与其他专家进行一轮正式评级的正式共识流程。
确定并审查了来自12个指南制定者的现有指南集；来自6个指南的适应性建议构成了证据基础，并为正式共识流程提供了依据，所有建议达成了75%或更高的共识。
对于资源有限的情况，结肠癌非梗阻性I-IIA期的推荐治疗方法：在基本资源和有限资源情况下，采用开放切除术；在资源丰富的情况下，由训练有素的外科医生进行腹腔镜或微创手术，除非有禁忌证。IIB-IIC期的治疗方法：在基本资源和有限资源情况下，遵循标准肿瘤学原则进行开放整块切除，若无法进行，则转至更高水平的医疗机构；在紧急情况下，仅限于挽救生命的手术；在资源丰富的情况下，请进行腹腔镜整块切除，若无法进行，则改为开放手术。梗阻性IIB-IIC期的治疗方法：在基本资源情况下，进行切除和/或改道；在有限资源或资源丰富的情况下，进行急诊手术切除。左侧IIB-IIC期的治疗方法：在资源丰富的情况下，可放置结肠支架。T4N0/T3N0高危特征或II期高危梗阻性直肠癌的治疗方法：在资源丰富的情况下，可提供辅助化疗。cT1N0和cT2n0直肠癌的治疗方法：在基本资源、有限资源或资源丰富的情况下，遵循全直肠系膜切除原则。cT3n0的治疗方法：在基本资源和有限资源情况下，进行全直肠系膜切除，若无法进行，则改道。未接受新辅助化疗的高危患者的治疗方法：在基本资源、有限资源或资源丰富的情况下，可提供辅助治疗。可切除的cT3N0直肠癌的治疗方法：在资源丰富的情况下，根据术前因素进行新辅助化疗。对于治疗后的监测，结合病史、体格检查、癌胚抗原检测、影像学检查和内镜检查进行。频率取决于具体情况。资源丰富情况下的建议在指南中给出。更多信息可在www.asco.org/resource-stratified-guidelines上找到。
美国临床肿瘤学会认为，医疗保健提供者和医疗保健系统决策者应以可获得的最高资源层级的建议为指导。本指南旨在补充而非取代当地指南。
