title: Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO).
abstract: In rectal cancer management, accurate staging by magnetic resonance imaging, neo-adjuvant treatment with the use of radiotherapy, and total mesorectal excision have resulted in remarkable improvement in the oncological outcomes. However, there is substantial discrepancy in the therapeutic approach and failure to adhere to international guidelines among different Greek-Cypriot hospitals. The present guidelines aim to aid the multidisciplinary management of rectal cancer, considering both the local special characteristics of our healthcare system and the international relevant agreements (ESMO, EURECCA). Following background discussion and online communication sessions for feedback among the members of an executive team, a consensus rectal cancer management was obtained. Statements were subjected to the Delphi methodology voting system on two rounds to achieve further consensus by invited multidisciplinary international experts on colorectal cancer. Statements were considered of high, moderate or low consensus if they were voted by ≥80%, 60-80%, or <60%, respectively; those obtaining a low consensus level after both voting rounds were rejected. One hundred and two statements were developed and voted by 100 experts. The mean rate of abstention per statement was 12.5% (range: 2-45%). In the end of the process, all statements achieved a high consensus. Guidelines and algorithms of diagnosis and treatment were proposed. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized.
authors.affiliation: General Surgery, InterClinic Hospital of Heraklion, Greece (Evangelos Xynos).
authors.forename: Evaghelos
authors.initials: E
authors.lastname: Xynos
authors.affiliation: Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Paris Tekkis, Panagiotis Georgiou).
authors.forename: Paris
authors.initials: P
authors.lastname: Tekkis
authors.affiliation: General Surgery, Metropolitan Hospital of Piraeus, Greece (Nikolaos Gouvas).
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Gouvas
authors.affiliation: Radiation Oncology, Iatriko Center of Athens, Greece (Louza Vini).
authors.forename: Louiza
authors.initials: L
authors.lastname: Vini
authors.affiliation: Radiology, University Hospital of Heraklion, Greece (Evangelia Chrysou).
authors.forename: Evangelia
authors.initials: E
authors.lastname: Chrysou
authors.affiliation: Pathology, University Hospital of Heraklion, Greece (Maria Tzardi).
authors.forename: Maria
authors.initials: M
authors.lastname: Tzardi
authors.affiliation: Radiation Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Vassilis Vassiliou).
authors.forename: Vassilis
authors.initials: V
authors.lastname: Vassiliou
authors.affiliation: Medical Oncology, Bioclinic of Thessaloniki, Greece (Ioannis Boukovinas).
authors.forename: Ioannis
authors.initials: I
authors.lastname: Boukovinas
authors.affiliation: General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, George Pechlivanides).
authors.forename: Christos
authors.initials: C
authors.lastname: Agalianos
authors.affiliation: Medical Oncology, Venizeleion Hospital of Heraklion, Greece (Nikolaos Androulakis).
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Androulakis
authors.affiliation: Medical Oncology, Koutlibaneion Hospital of Larissa, Greece (Athanasios Athanasiadis).
authors.forename: Athanasios
authors.initials: A
authors.lastname: Athanasiadis
authors.affiliation: Medical Oncology, Metropolitan Hospital of Piraeus, Greece (Christos Christodoulou).
authors.forename: Christos
authors.initials: C
authors.lastname: Christodoulou
authors.affiliation: General Surgery, Konstantopouleio Hospital of Athens, Greece (Christos Dervenis).
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.affiliation: Medical Oncology, Interbalkan Medical Center, Thessaloniki, Greece (Christos Emmanouilidis).
authors.forename: Christos
authors.initials: C
authors.lastname: Emmanouilidis
authors.affiliation: Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Paris Tekkis, Panagiotis Georgiou).
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Georgiou
authors.affiliation: Medical Oncology, Iaso General Hospital, Athens, Greece (Ourania Katopodi).
authors.forename: Ourania
authors.initials: O
authors.lastname: Katopodi
authors.affiliation: Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Panteleimon Kountourakis, Demetris Papamichael).
authors.forename: Panteleimon
authors.initials: P
authors.lastname: Kountourakis
authors.affiliation: Medical Oncology, University Hospital of Patras, Greece (Thomas Makatsoris).
authors.forename: Thomas
authors.initials: T
authors.lastname: Makatsoris
authors.affiliation: Medical Oncology, Ippokrateion Hospital of Athens, Greece (Pavlos Papakostas).
authors.forename: Pavlos
authors.initials: P
authors.lastname: Papakostas
authors.affiliation: Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Panteleimon Kountourakis, Demetris Papamichael).
authors.forename: Demetris
authors.initials: D
authors.lastname: Papamichael
authors.affiliation: General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, George Pechlivanides).
authors.forename: George
authors.initials: G
authors.lastname: Pechlivanides
authors.affiliation: Medical Oncology, University Hospital of Ioannina, Greece (Georgios Pentheroudakis).
authors.forename: Georgios
authors.initials: G
authors.lastname: Pentheroudakis
authors.affiliation: Gastroenterology, Theageneion Cancer Hospital, Thessaloniki, Greece (Ioannis Pilpilidis).
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pilpilidis
authors.affiliation: Medical Oncology, Agioi Anargyroi Hospital of Athens, Greece (Joseph Sgouros).
authors.forename: Joseph
authors.initials: J
authors.lastname: Sgouros
authors.affiliation: Radiology, Konstantopouleio Hospital of Athens, Greece (Charina Triantopoulou).
authors.forename: Charina
authors.initials: C
authors.lastname: Triantopoulou
authors.affiliation: Medical Oncology, George Gennimatas General Hospital, Athens, Greece (Spyridon Xynogalos).
authors.forename: Spyridon
authors.initials: S
authors.lastname: Xynogalos
authors.affiliation: Medical Oncology, Dexeus University Institute, Barcelona, Spain (Niki Karachaliou).
authors.forename: Niki
authors.initials: N
authors.lastname: Karachaliou
authors.affiliation: Medical Oncology, Metaxas Cancer Hospital, Piraeus, Greece (Nikolaos Ziras).
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Ziras
authors.affiliation: General Surgery, University Hospital of Heraklion, Greece (Odysseas Zoras).
authors.forename: Odysseas
authors.initials: O
authors.lastname: Zoras
authors.affiliation: Medical Oncology, University Hospital of Heraklion, Greece (John Souglakos).
authors.forename: John
authors.initials: J
authors.lastname: Souglakos
keywords: Delphi; Guidelines; consensus; rectal cancer; surgical treatment