Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer

Yojiro Hashiguchi, Kei Muro, Yutaka Saito, Yoshinori Ito, Yoichi Ajioka, Tetsuya Hamaguchi, Kiyoshi Hasegawa, Kinichi Hotta, Hideyuki Ishida, Megumi Ishiguro, Soichiro Ishihara, Yukihide Kanemitsu, Yusuke Kinugasa, Keiko Murofushi, Takako Eguchi Nakajima, Shiro Oka, Toshiaki Tanaka, Hiroya Taniguchi, Akihito Tsuji, Keisuke Uehara, Hideki Ueno, Takeharu Yamanaka, Kentaro Yamazaki, Masahiro Yoshida, Takayuki Yoshino, Michio Itabashi, Kentaro Sakamaki, Keiji Sano, Yasuhiro Shimada, Shinji Tanaka, Hiroyuki Uetake, Shigeki Yamaguchi, Naohiko Yamaguchi, Hirotoshi Kobayashi, Keiji Matsuda, Kenjiro Kotake, Kenichi Sugihara, Japanese Society for Cancer of the Colon and Rectum, Yojiro Hashiguchi, Kei Muro, Yutaka Saito, Yoshinori Ito, Yoichi Ajioka, Tetsuya Hamaguchi, Kiyoshi Hasegawa, Kinichi Hotta, Hideyuki Ishida, Megumi Ishiguro, Soichiro Ishihara, Yukihide Kanemitsu, Yusuke Kinugasa, Keiko Murofushi, Takako Eguchi Nakajima, Shiro Oka, Toshiaki Tanaka, Hiroya Taniguchi, Akihito Tsuji, Keisuke Uehara, Hideki Ueno, Takeharu Yamanaka, Kentaro Yamazaki, Masahiro Yoshida, Takayuki Yoshino, Michio Itabashi, Kentaro Sakamaki, Keiji Sano, Yasuhiro Shimada, Shinji Tanaka, Hiroyuki Uetake, Shigeki Yamaguchi, Naohiko Yamaguchi, Hirotoshi Kobayashi, Keiji Matsuda, Kenjiro Kotake, Kenichi Sugihara, Japanese Society for Cancer of the Colon and Rectum

Abstract

The number of deaths from colorectal cancer in Japan continues to increase. Colorectal cancer deaths exceeded 50,000 in 2016. In the 2019 edition, revision of all aspects of treatments was performed, with corrections and additions made based on knowledge acquired since the 2016 version (drug therapy) and the 2014 version (other treatments). The Japanese Society for Cancer of the Colon and Rectum guidelines 2019 for the treatment of colorectal cancer (JSCCR guidelines 2019) have been prepared to show standard treatment strategies for colorectal cancer, to eliminate disparities among institutions in terms of treatment, to eliminate unnecessary treatment and insufficient treatment and to deepen mutual understanding between healthcare professionals and patients by making these guidelines available to the general public. These guidelines have been prepared by consensuses reached by the JSCCR Guideline Committee, based on a careful review of the evidence retrieved by literature searches and in view of the medical health insurance system and actual clinical practice settings in Japan. Therefore, these guidelines can be used as a tool for treating colorectal cancer in actual clinical practice settings. More specifically, they can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient. Controversial issues were selected as clinical questions, and recommendations were made. Each recommendation is accompanied by a classification of the evidence and a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here, we present the English version of the JSCCR guidelines 2019.

Keywords: Chemotherapy; Colorectal cancer; Endoscopy; Guideline; Radiotherapy; Surgery.

Conflict of interest statement

(1) The following corporations were disclosed by self-declaration of the Guideline Committee members and Guideline Evaluation Committee members. (2) A2 Healthcare Corp., Akita Sumitomo Co., Ltd., Array Biopharma Inc., Astellas Pharma Inc., Bayer Yakuhin, Ltd., Bristol-Myers Squibb Company, Chugai Pharmaceutical Co., Ltd., Covidien Japan, Inc., DAIICHI SANKYO COMPANY, Ltd., EA Pharma Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Gilead Sciences, Inc., Intuitive Surgical, Inc., Japan Clinical Research Operations, Johnson & Johnson K.K., Kaigen Pharma Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mediscience Planning Inc., Merck Serono Co., Ltd., Merck Biopharma Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MRP Co., Ltd., MSD K.K., NanoCarrier Co., Ltd., Nippon Boehringer lngelheim Co., Ltd., Olympus Corporation, Ono pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi K.K., Shimadzu Corporation, Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Sysmex Corporation, Taiho pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited., TERUMO CORPORATION, Yakult Honsha Co., Ltd. ((2) Measures for the conflicts of interest:The Guideline Committee and the Guideline Evaluation Committee have been organized in members with a diverse range of disciplines, including surgery, internal medicine, radiology, pathology, etc., in order to minimize biased opinion. Each recommendation was made determined not on an individual opinion basis but based on voting by the whole committee members, with consensus prioritized. When voting for CQ, conflicts in relation to economic and academic interests were confirmed for each CQ, and members with conflicts of interest in the CQ abstained from voting.

Figures

Fig. 1
Fig. 1
Treatment strategies for cTis and cT1 colorectal cancer
Fig. 2
Fig. 2
Surgical treatment strategies for cStage 0 to cStage III colorectal cancer
Fig. 3
Fig. 3
Treatment strategies for Stage IV colorectal cancer
Fig. 4
Fig. 4
Treatment strategies for recurrent colorectal cancer
Fig. 5
Fig. 5
Treatment strategies for hematogenous metastases
Fig. 6
Fig. 6
Steps in the decision-making process for the first-line treatment in unresectable colorectal cancer
Fig. 7
Fig. 7
Systemic therapy algorithm for unresectable colorectal cancer
Fig. 8
Fig. 8
An example of a surveillance schedule after curative resection of pStage I to pStage III colorectal cancer
Fig. 9
Fig. 9
Cumulative incidence of recurrence according to stage (JSCCR colorectal cancer registry: patients in the year 2007)
Fig. 10
Fig. 10
Cumulative incidence of recurrence according to the site of recurrence (JSCCR colorectal cancer registry: patients in the year 2007)
Fig. 11
Fig. 11
Treatment strategies for pT1 cancer after endoscopic resection

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