title: Clinical practice guidelines for the management of metastatic colorectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO).
abstract: There is discrepancy and failure to adhere to current international guidelines for the management of metastatic colorectal cancer (CRC) in hospitals in Greece and Cyprus. The aim of the present document is to provide a consensus on the multidisciplinary management of metastastic CRC, considering both special characteristics of our Healthcare System and international guidelines. Following discussion and online communication among the members of an executive team chosen by the Hellenic Society of Medical Oncology (HeSMO), a consensus for metastastic CRC disease was developed. Statements were subjected to the Delphi methodology on two voting rounds by invited multidisciplinary international experts on CRC. Statements reaching level of agreement by ≥80% were considered as having achieved large consensus, whereas statements reaching 60-80% moderate consensus. One hundred and nine statements were developed. Ninety experts voted for those statements. The median rate of abstain per statement was 18.5% (range: 0-54%). In the end of the process, all statements achieved a large consensus. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. R0 resection is the only intervention that may offer substantial improvement in the oncological outcomes.
authors.affiliation: General Surgery, "Konstantopouleio" Hospital of Athens, Greece (Christos Dervenis).
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.affiliation: General Surgery, "InterClinic" Hospital of Heraklion, Greece (Evangelos Xynos).
authors.forename: Evaghelos
authors.initials: E
authors.lastname: Xynos
authors.affiliation: General Surgery, "Laikon" Hospital of Athens, Greece (George Sotiropoulos).
authors.forename: George
authors.initials: G
authors.lastname: Sotiropoulos
authors.affiliation: General Surgery, "METROPOLITAN" Hospital of Piraeus, Greece (Nikolaos Gouvas).
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Gouvas
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, Ioannis Kyriazanos, 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: Radiology, University Hospital of Heraklion, Greece (Evangelia Chrysou).
authors.forename: Evangelia
authors.initials: E
authors.lastname: Chrysou
authors.affiliation: Medical Oncology, "Interbalkan" Medical Center, Thessaloniki, Greece (Christos Emmanoulidis).
authors.forename: Christos
authors.initials: C
authors.lastname: Emmanouilidis
authors.affiliation: Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Panagiotis Georgiou, Paris Tekkis).
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Georgiou
authors.affiliation: Medical Oncology, Dexeus University Institut, Barcelona, Spain (Niki Carachaliou).
authors.forename: Niki
authors.initials: N
authors.lastname: Karachaliou
authors.affiliation: Medical Oncology, "Iaso" General Hospital, Athens, Greece (Ourania Katopoidi).
authors.forename: Ourania
authors.initials: O
authors.lastname: Katopodi
authors.affiliation: Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Pandelis Kountourakis, Demetris Papamichael).
authors.forename: Panteleimon
authors.initials: P
authors.lastname: Kountourakis
authors.affiliation: General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, Ioannis Kyriazanos, George Pechlivanides).
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kyriazanos
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 (Pandelis Kountourakis, Demetris Papamichael).
authors.forename: Demetris
authors.initials: D
authors.lastname: Papamichael
authors.affiliation: General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, Ioannis Kyriazanos, 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: Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Panagiotis Georgiou, Paris Tekkis).
authors.forename: Paris
authors.initials: P
authors.lastname: Tekkis
authors.affiliation: Radiology, "Konstantopouleio" Hospital of Athens, Greece (Charina Triantopoulou).
authors.forename: Charina
authors.initials: C
authors.lastname: Triantopoulou
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: Radiation Oncology, "Iatriko" Center of Athens, Greece (Lousa Vini).
authors.forename: Louiza
authors.initials: L
authors.lastname: Vini
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, "Metaxas" Cancer Hospital, Piraeus, Greece (Nikolaos Ziras).
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Ziras
authors.affiliation: Medical Oncology, University Hospital of Heraklion, Greece (John Souglakos).
authors.forename: John
authors.initials: J
authors.lastname: Souglakos
keywords: Colorectal cancer; guidelines; metastatic disease; surgery