Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)

Authors Evaghelos Xynos, Paris Tekkis, Nikolaos Gouvas, Louiza Vini, Evangelia Chrysou, Maria Tzardi, Vassilis Vassiliou, Ioannis Boukovinas, Christos Agalianos, Nikolaos Androulakis, Athanasios Athanasiadis, Christos Christodoulou, Christos Dervenis, Christos Emmanouilidis, Panagiotis Georgiou, Ourania Katopodi, Panteleimon Kountourakis, Thomas Makatsoris, Pavlos Papakostas, Demetris Papamichael, George Pechlivanides, Georgios Pentheroudakis, Ioannis Pilpilidis, Joseph Sgouros, Charina Triantopoulou, Spyridon Xynogalos, Niki Karachaliou, Nikolaos Ziras, Odysseas Zoras, John Souglakos.


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.

Keywords Guidelines, rectal cancer, surgical treatment, consensus, Delphi

Ann Gastroenterol 2016; 29 (2): 103-126


Special Article