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      Comparison of guidelines for the management of rectal cancer

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          Abstract

          A comparison between NCCN, ESMO and JSCCR Guidelines is presented, concerning the treatment of rectal cancer, with an analysis and discussion of their discrepancies.

          Differences indicate areas for research

          Translated abstract

          Background

          Overall survival from rectal cancer has almost doubled over the last 20 years. Following recommendations in management guidelines plays some part in this, but the extent of discrepancies between them has not been evaluated.

          Methods

          National Comprehensive Cancer Network (NCCN, USA), European Society for Medical Oncology (ESMO, Europe) and Japanese Society for Cancer of the Colon and Rectum (JSCCR, Japan) guidelines were examined and compared. These were chosen as representative of the countries with the highest incidences of rectal cancer and because no previous collaborations among societies were found.

          Results

          Overall agreement among societies was found regarding the definition of total mesorectal excision as the surgical standard, the administration of adjuvant therapy for stage III disease, indications for surgical resection for metastases and/or recurrent disease, and the treatment of peritoneal disease. Discrepancies emerged, in particular between Western and Japanese guidelines. The most significant differences involved the endoscopic approach to early cancer, extended lymph node dissection, adjuvant treatment for patients with stage I and II disease, neoadjuvant chemotherapy, the specific management of metachronous disease, and restaging strategies.

          Conclusion

          There are major discrepancies among guidelines. These differences should constitute topics for further research.

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          Most cited references34

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          Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

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            Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

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              Tumor budding in colorectal cancer--ready for diagnostic practice?

              Tumor budding is an important additional prognostic factor for patients with colorectal cancer (CRC). Defined as the presence of single tumor cells or small clusters of up to 5 cells in the tumor stroma, tumor budding has been likened to an epithelial-mesenchymal transition. Based on well-designed retrospective studies, tumor budding is linked to adverse outcome of CRC patients in 3 clinical scenarios: (1) in malignant polyps, detection of tumor buds is a risk factor for lymph node metastasis indicating the need for colorectal surgery; (2) tumor budding in stage II CRC is a highly adverse prognostic indicator and may aid patient selection for adjuvant therapy; (3) in the preoperative setting, presence of tumor budding in biopsy material may help to identify high-risk rectal cancer patients for neoadjuvant therapy. However, lack of consensus guidelines for standardized assessment still limits reporting in daily diagnostic practice. This article provides a practical and comprehensive overview on tumor budding aimed at the practicing pathologist. First, we review the prognostic value of tumor budding for the management of colon and rectal cancer patients. Second, we outline a practical, evidence-based proposal for the assessment of tumor budding in the daily sign-out. Last, we summarize the current knowledge of the molecular characteristics of high-grade budding tumors in the context of personalized treatment approaches and biomarker discovery.
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                Author and article information

                Contributors
                c.kontovounisios@imperial.ac.uk
                Journal
                BJS Open
                BJS Open
                10.1002/(ISSN)2474-9842
                BJS5
                BJS Open
                John Wiley & Sons, Ltd (Chichester, UK )
                2474-9842
                27 July 2018
                December 2018
                : 2
                : 6 ( doiID: 10.1002/bjs5.2018.2.issue-6 )
                : 433-451
                Affiliations
                [ 1 ] Department of Surgical Sciences Azienda Ospedaliero – Universitaria di Parma Parma Italy
                [ 2 ] Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences Universtià della Campania ‘Luigi Vanvitelli’ Naples Italy
                [ 3 ] Department of Colorectal Surgery Royal Marsden Hospital London UK
                [ 4 ] Department of Surgery and Cancer Imperial College London London UK
                [ 5 ] Department of Colorectal Surgery Chelsea and Westminster Hospital London UK
                Author notes
                [*] [* ] Correspondence to: Mr C. Kontovounisios, Department of Colorectal Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK (e‐mail: c.kontovounisios@ 123456imperial.ac.uk ; @ckontovo)
                Author information
                https://orcid.org/0000-0002-6888-1137
                https://orcid.org/0000-0002-8322-6421
                https://orcid.org/0000-0001-8699-4621
                Article
                BJS588
                10.1002/bjs5.88
                6254003
                30511044
                3f62715a-6082-49c6-b297-3136132fbcb1
                © 2018 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 March 2018
                : 18 May 2018
                Page count
                Figures: 0, Tables: 5, Pages: 19, Words: 8086
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                bjs588
                December 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.3 mode:remove_FC converted:26.11.2018

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