title: EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum.
abstract: BACKGROUND
  Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries.
  
  
  METHODS
  The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and metastatic colorectal disease separately. Moreover, evidence based algorithms for diagnostics and treatment were composed which were also submitted to the Delphi process.
  
  
  RESULTS
  The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members.
  
  
  CONCLUSIONS
  Multidisciplinary consensus on key diagnostic and treatment issues for colon and rectal cancer management using the Delphi method was successful. This consensus document embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.
authors.affiliation: EURECCA and CC3, European Cancer Organization, European Society of Surgical Oncology, Department of Surgery, Leiden University Medical Center, The Netherlands. Electronic address: c.j.h.van_de_velde@lumc.nl.
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: CC3, EURECCA, Department of Surgery, Leiden University Medical Center, The Netherlands.
authors.forename: Petra G
authors.initials: PG
authors.lastname: Boelens
authors.affiliation: European Cancer Organization/EPAAC Catalonian Cancer Strategy Unit, Department of Health, and IDIBELL, University of Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Borras
authors.affiliation: Epidemiology, Erasmus MC Rotterdam, and Research Department, Comprehensive Cancer Centre South, Eindhoven, The Netherlands.
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Coebergh
authors.affiliation: Executive Board European Society Medical Oncology, Institute of Health Research INCLIVA, University of Valencia, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: Cervantes
authors.affiliation: European Society Radiology, Department of Diagnostic Radiology, Karolinska University Hospital and Danderyds Hospital, Stockholm, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Blomqvist
authors.affiliation: European Society Radiology, Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Regina G H
authors.initials: RG
authors.lastname: Beets-Tan
authors.affiliation: CC3, EURECCA, Department of Surgery, Leiden University Medical Center, The Netherlands.
authors.forename: Colette B M
authors.initials: CB
authors.lastname: van den Broek
authors.affiliation: European Society Radiology, Department of Radiology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, UK.
authors.forename: Gina
authors.initials: G
authors.lastname: Brown
authors.affiliation: European Society Medical Oncology, EuropaColon, Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Cutsem
authors.affiliation: Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Eloy
authors.initials: E
authors.lastname: Espin
authors.affiliation: ESTRO, EORTC, Department of Radiation Oncology, University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium.
authors.forename: Karin
authors.initials: K
authors.lastname: Haustermans
authors.affiliation: ESTRO, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.affiliation: Aarhus University Hospital, Department of Surgery, Aarhus, Denmark.
authors.forename: Lene H
authors.initials: LH
authors.lastname: Iversen
authors.affiliation: European Society Pathology, Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: J Han
authors.initials: JH
authors.lastname: van Krieken
authors.affiliation: ESTRO, Department of Clinical Oncology, Leiden University Medical center, The Netherlands.
authors.forename: Corrie A M
authors.initials: CA
authors.lastname: Marijnen
authors.affiliation: EUROPAColon, Unit 5, Deans Farm, Stratford sub Castle, Salisbury SP1 3YP, UK.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Henning
authors.affiliation: EUROPAColon, Unit 5, Deans Farm, Stratford sub Castle, Salisbury SP1 3YP, UK.
authors.forename: Jola
authors.initials: J
authors.lastname: Gore-Booth
authors.affiliation: Cattedra di Radioterapia, Università Cattolica S. Cuore, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Meldolesi
authors.affiliation: ESCP, Department of General, Visceral and Vascular Surgery, Otto-von-Guericke University of Magdeburg, Germany.
authors.forename: Pawel
authors.initials: P
authors.lastname: Mroczkowski
authors.affiliation: European Society Pathology, Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Nagtegaal
authors.affiliation: European Society of Surgical Oncology, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Naredi
authors.affiliation: Spanish Society of Surgeons, ESCP, Department of Surgery, Public University of Navarra, Spain.
authors.forename: Hector
authors.initials: H
authors.lastname: Ortiz
authors.affiliation: European Society of Surgical Oncology, ESCP, Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Påhlman
authors.affiliation: European Society Pathology, Yorkshire Cancer Research Centenary Pathology and Tumour Biology, Leeds Institute of Cancer studies and Pathology, Leeds University, Leeds, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Quirke
authors.affiliation: ESTRO Radiation Oncologist, University Hospital of Frankfurt, Frankfurt, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Rödel
authors.affiliation: European Society of Surgical Oncology, Oncosurgery Unit, HUG, Geneva, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Roth
authors.affiliation: European Society of Surgical Oncology, Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Harm
authors.initials: H
authors.lastname: Rutten
authors.affiliation: European Society Medical Oncology, Department of Oncology/Haematology, Martin Luther University Halle, Germany.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schmoll
authors.affiliation: European Society of Surgical Oncology, Department of Colorectal Surgery, West Middlesex University Hospital, Isleworth, UK.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Smith
authors.affiliation: ESSO, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.affiliation: EONS St. Mark's Hospital, Harrow, Middlesex, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Taylor
authors.affiliation: European Society of Surgical Oncology, ESCP, Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Wibe
authors.affiliation: European Society of Surgical Oncology, Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Wiggers
authors.affiliation: Cattedra di Radioterapia, Università Cattolica S. Cuore, Rome, Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Gambacorta
authors.affiliation: CC3, Radiation Oncology Section,Department of Surgery, Radiology and Dentistry, University of Perugia, Italy.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aristei
authors.affiliation: CC3, ESTRO, Professor Cattedra di Radioterapia, Università Cattolica S. Cuore, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
mesh_terms: D003110:Colonic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005060:Europe; D006801:Humans; D020360:Neoadjuvant Therapy; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Adjuvant treatment; Audit; Colon cancer; Consensus; Delphi method; Multidisciplinary teams; Neoadjuvant treatment; Quality assurance; Rectal cancer; Surgery