Colon Cancer
Authors: Peeters Marc , Leroy Roos , Robays Jo , Veereman Geneviève , Bielen Didier , Ceelen Wim , Danse E. , De Man Marc , Demetter Pieter , Flamen P. , Hendlisz Alain , Sinapi Isabelle , Vanbeckevoort Dirk , Van Cutsem Eric , Ysebaert Dirk , van Gils Paul , Veerbeek Laetitia , Smit Yolba , Verleye Leen 
Published: January 2025

SCIENTIFIC REPORT 10 -- 1 INTRODUCTION 10 -- 1.1 BACKGROUND 10 -- 1.2 THE NEED FOR A GUIDELINE 11 -- 1.3 INTERNATIONAL COLLABORATION 11 -- 1.4 SCOPE 11 -- 1.5 REMIT OF THE GUIDELINE 11 -- 1.5.1 Overall objectives 11 -- 1.5.2 Target users of the guideline 11 -- 1.6 STATEMENT OF INTENT 12 -- 1.7 FUNDING AND DECLARATION OF INTEREST 12 -- 2 METHODOLOGY 12 -- 2.1 INTRODUCTION 12 -- 2.2 GUIDELINE DEVELOPMENT GROUP 12 -- 2.3 CLINICAL RESEARCH QUESTIONS 13 -- 2.4 GENERAL APPROACH 14 -- 2.5 LITERATURE SEARCH AND STUDY SELECTION 14 -- 2.5.1 Literature review 14 -- 2.6 QUALITY APPRAISAL 15 -- 2.6.1 Clinical practice guidelines 16 -- 2.6.2 Systematic reviews 16 -- 2.6.3 Primary articles 16 -- 2.7 DATA EXTRACTION AND EVIDENCE SUMMARY 16 -- 2.8 STATISTICAL ANALYSIS 16 -- 2.9 GRADING EVIDENCE 16 -- 2.10 FORMULATION OF RECOMMENDATIONS 19 -- 2.11 EXTERNAL REVIEW 20 -- 2.11.1 Healthcare professionals 20 -- 2.11.2 Patient representatives 21 -- 2.12 FINAL VALIDATION 21 -- 3 RECOMMENDATIONS 21 -- 3.1 DIAGNOSIS 21 -- 3.2 STAGING OF INVASIVE COLON CANCER 22 -- 3.2.1 CT chest-abdomen 22 -- 3.2.2 FDG PET-CT for staging 23 -- 3.2.3 MRI liver 25 -- 3.2.4 Multidisciplinary team (MDT) meetings 27 -- 3.3 PATHOLOGY 28 -- 3.3.1 KRAS mutational analysis 28 -- 3.3.2 BRAF 30 -- 3.3.3 N-RAS as a predictor of treatment effectiveness 31 -- 3.3.4 MSI testing as a predictor of treatment effectiveness 31 -- 3.3.5 Standards for pathology report 33 -- 3.3.6 Number of lymph nodes 33 -- 3.4 SURGICAL TREATMENT STAGE 0-III 34 -- 3.4.1 Endoscopic treatment stage I: polypectomy 34 -- 3.4.2 Laparoscopic vs. open surgery 36 -- 3.4.3 Surgical technique: complete mesocolic excision 41 -- 3.4.4 Enhanced recovery after surgery (ERAS) 42 -- 3.5 TREATMENT OF ACUTE OBSTRUCTIONS 47 -- 3.6 ADJUVANT CHEMOTHERAPY FOR STAGE II-III COLON CANCER 52 -- 3.6.1 (High risk) stage II colon cancer 52 -- 3.6.2 Stage III colon cancer 53 -- 3.6.3 Adjuvant chemotherapy in elderly patients 54 -- 3.7 SURGICAL TREATMENT OF LIVER METASTASES 57 -- 3.7.1 Timing of surgical resection of primary tumour and synchronous liver metastasis 57 -- 3.7.2 Neoadjuvant, perioperative and adjuvant chemotherapy 59 -- 3.8 LOCAL TREATMENT MODALITIES FOR UNRESECTABLE LIVER METASTASES 61 -- 3.8.1 Radio-frequency ablation (RFA) 61 -- 3.8.2 Hepatic artery chemotherapy in unresectable CRC liver metastases 62 -- 3.8.3 Chemo-embolisation of unresectable CRC liver metastases 63 -- 3.8.4 Radio-embolisation, Selective Internal Radiation Therapy (SIRT) for patients with -- unresectable tumours 64 -- 3.8.5 Stereotactic Body Radiation Therapy (SBRT) for liver metastases 66 -- 3.9 LOCAL TREATMENT OF LUNG METASTASES 67 -- 3.9.1 Stereotactic Body Radiation Therapy (SBRT) for lung metastases 67 -- 3.9.2 Resection of lung metastases 67 -- 3.10 TREATMENT OF PERITONEAL METASTASES: CYTOREDUCTIVE SURGERY AND -- HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC) 69 -- 3.11 TREATMENT OF METASTATIC COLON CANCER: FIRST-LINE CHEMOTHERAPY -- +/- TARGETED THERAPY. 71 -- 3.11.1 Choice of chemotherapy agents 71 -- 3.11.2 Sequential versus combined chemotherapy 76 -- 3.11.3 Targeted therapy 77 -- 3.12 SECOND LINE CHEMOTHERAPY FOR METASTATIC COLON CANCER 84 -- 3.13 FOLLOW-UP 85 -- 3.13.1 Summary of guidelines 85 -- 3.13.2 General recommendations 85 -- 3.13.3 CEA 85 -- 3.13.4 Colonoscopy 85 -- 3.13.5 Imaging 85 -- 3.13.6 Other tests 85 -- 3.13.7 Update on the use of CT chest abdomen in follow-up 86 -- 4 IMPLEMENTATION AND UPDATING OF THE GUIDELINE 87 -- 4.1 IMPLEMENTATION 87 -- 4.1.1 Multidisciplinary approach 87 -- 4.1.2 Patient-centred care 87 -- 4.1.3 Dissemination and implementation of this guideline 87 -- 4.2 MONITORING THE QUALITY OF CARE 88 -- 4.3 GUIDELINE UPDATE 88 -- REFERENCES 89