The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer

Vogel, Jon D.; Felder, Seth; Bhama, Anuradha R.; Hawkins, Alexander T.; Langenfeld, Sean J.; Shaffer, Virginia; Thorsen, Amy J.; Weiser, Martin R.; Chang, George J.; Lightner, Amy L.; Feingold, Daniel L.; Paquette, Ian M.

doi:10.1097/dcr.0000000000002323

Cited by 139 publications

(126 citation statements)

References 336 publications

(481 reference statements)

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“…Adjuvant chemotherapy in the presence of locally advanced rectal cancer might not change the prognosis as there has been inconsistency in its benefits. Education and increasing the awareness of parents and health workers in primary care or pediatricians play a major role in dealing with this syndrome [ 1 , 12 , 14 - 16 ].…”

Section: Discussionmentioning

confidence: 99%

A Constitutional Mismatch Repair Deficiency Syndrome Presented With an Advanced Rectal Cancer in a Juvenile Female: A Case Report and Literature Review

Alali¹,

Zikry²,

Zayed³

et al. 2022

Cureus

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The constitutional mismatch repair deficiency (CMMRD) syndrome is a rare and challenging condition with a poor prognosis. It results from biallelic mismatch repair gene mutations and leads to multiorgan cancers. Therefore, we report the first case of advanced juvenile rectal cancer related to CMMRD syndrome in the Gulf region. She is a 13-year-old female, born to non-consanguineous parents with a positive family history of malignancy, presented with an eight-month history of a retractable bulging anal mass associated with diarrhea mixed with blood and constitutional symptoms. She was cachectic with café au lait spots all over her body. Upon investigation, she was found to have invasive rectal adenocarcinoma. The case was started on neoadjuvant chemoradiotherapy in addition to genetic testing which showed a homozygous pathogenic variant in PMS2, indicating CMMRD syndrome. The patient underwent pre-operative post-neoadjuvant reassessment followed by laparoscopic total proctocolectomy with ileal J-pouch creation and ileoanal anastomosis with temporary diverting loop ileostomy which later on was reversed with no complications or recurrence. The family declined to continue the adjuvant therapy but accepted the surveillance programs and genetic testing. Unusual or late presentation secondary to a very rare syndrome like CMMRD is a major challenge to clinicians, hence a high index of suspicion and proper utilization of genetics programs might be the best available solutions.

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Section: Discussionmentioning

confidence: 99%

A Constitutional Mismatch Repair Deficiency Syndrome Presented With an Advanced Rectal Cancer in a Juvenile Female: A Case Report and Literature Review

Alali¹,

Zikry²,

Zayed³

et al. 2022

Cureus

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“…10 The 2B evidence grade and the wording of the recommendation should be reconsidered. The only RCT evidence suggests no major benefit and the observational evidence is not “exceptionally strong.” 2…”

Section: To the Editor—mentioning

confidence: 99%

“…We appreciated seeing the randomized controlled trial (RCT), Pulmonary Metastasectomy in Colorectal Cancer (PulMICC), 1 cited in the Guidelines for the Management of Colon Cancer. 2 PulMiCC was accurately quoted as finding that patients randomly assigned to have metastasectomy had shorter median survival time (3.5 [95% CI, 3.1–6.6] years) compared with controls (3.8 [3.5–4.6] years). Yet the guidance is that “resection of the lung lesions should be considered because it may prolong survival.”…”

Section: To the Editor—mentioning

confidence: 99%

A Comment on the American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer

Macbeth

Williams

Treasure

2022

Diseases of the Colon &Amp; Rectum

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“…Although the evidence on this subject is limited and with conflicting results, we believe we have presented that evidence fairly. We cited 3 large observational studies from high-impact journals citing positive results with pulmonary metastectomy and balanced this discussion by showing the negative results of the Pulmonary Metastasectomy in Colorectal Cancer study, stating that “nonsurgical treatment should also be considered.” 1–5 Williams et al cite the limitations of the Pulmonary Metastasectomy in Colorectal Cancer trial in their editorial. It is important to note that there is no large, randomized trial with well-matched patient cohorts on this topic indicating some persistent clinical equipoise.…”

Section: To the Editor—mentioning

confidence: 99%

Reply

Paquette

2022

Diseases of the Colon &Amp; Rectum

Self Cite

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To the Editor-In response to the editorial by Williams et al, the American Society of Colon and Rectal Surgeons Clinical Practice Guidelines Committee stands by our statement on pulmonary metastectomy in stage 4 colon cancer. Although the evidence on this subject is limited and with conflicting results, we believe we have presented that evidence fairly. We cited 3 large observational studies from high-impact journals citing positive results with pulmonary metastectomy and balanced this discussion by showing the negative results of the Pulmonary Metastasectomy in Colorectal Cancer study, stating that "nonsurgical treatment should also be considered." [1][2][3][4][5] Williams et al cite the limitations of the Pulmonary Metastasectomy in Colorectal Cancer trial in their editorial. It is important to note that there is no large, randomized trial with well-matched patient cohorts on this topic indicating some persistent clinical equipoise. Clinical practice guidelines are meant to summarize the currently available clinical literature on a given topic. They are not intended to provide guidance for all patients under a given circumstance. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system of recommendations allows us to help the reader understand how strong the literature is on a given topic. A "2B" recommendation is a weak recommendation based on moderate-quality evidence. Moderate-quality evidence is randomized controlled trials with important limitations or strong evidence from observational studies. The benefits are closely balanced with the risks and burdens. 6 The weak recommendation indicates that the best action may differ depending on circumstances.

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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer

Abstract: Earn Continuing Education (CME) credit online at cme.lww.com. This activity has been approved for AMA PRA Category 1 credit. TM Funding/Support: None reported.

Cited by 139 publications

References 336 publications

A Constitutional Mismatch Repair Deficiency Syndrome Presented With an Advanced Rectal Cancer in a Juvenile Female: A Case Report and Literature Review

A Constitutional Mismatch Repair Deficiency Syndrome Presented With an Advanced Rectal Cancer in a Juvenile Female: A Case Report and Literature Review

A Comment on the American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer

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