Guideline for optimization of colorectal cancer surgery and pathology.
OBJECTIVE
There is evidence of gaps in care for colorectal cancer surgery related to obtaining negative resection margins and lymph node assessment. Recommendations on the surgical and pathological management of curable colon and rectal cancer were developed.


METHODS
A systematic review on colorectal resection margins and lymph nodes was conducted. This evidence, combined with evidence from existing guidelines and expert consensus, was used to develop recommendations. The draft guideline was reviewed by an expert panel and was externally reviewed by practitioners in Ontario, Canada.


RESULTS
The search of the recent literature identified 107 articles pertinent to resection margins and lymph node assessment. The majority of the evidence was of poor quality. Of the 63 practitioners who reviewed the guideline, 97% agreed with the draft recommendations and 92% thought that the report should be approved as a practice guideline.


CONCLUSIONS
Achieving optimized performance concerning margin status and lymph node assessment requires the coordinated efforts of surgeons and pathologists, as well as other medical professionals. Focus should be on ensuring that colorectal cancers are resected with negative (R0) margins and that an adequate number of lymph nodes are assessed to allow for accurate decision making relating to prognosis and adjuvant therapy.
Smith
Andrew J
AJ
Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. andy.smith@sunnybrook.ca
Driman
David K
DK
Spithoff
Karen
K
Hunter
Amber
A
McLeod
Robin S
RS
Simunovic
Marko
M
Langer
Bernard
B
D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D017410:Practice Guidelines as Topic; D012007:Rectum / Q000601:surgery