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Inclusion/exclusion criteria Relevance to diagnostic tests and preoperative assessments Results Four PubMed general papers. Remainder were on individual subjects. Colonography (virtual colonoscopy) appeared as the most important update. Section 8.1.5 Virtual colonoscopy has been added. Comments Each article was discussed by the writing groups and, if relevant, included in the chapter. A further meeting was held to review the current recommendations and decide whether change was necessary in view of the more recently published literature. In general, there was very little change to the chapter, apart from the increasing role of colonography. Chapter 9 — Management of epithelial polyps Search strategy Cochrane Library, PubMed Dates Updated 1999 document to September 2004 Search terms Colorectal epithelial polyps, hyperplastic polyps, management, headings of sections in chapter Inclusion/exclusion criteria Citations required to address search terms, or be rejected Results Cochrane Library: seven references, one systematic review not relevant, three RCTs, two EBM, one clinical evidence PubMed: seven RCTs — one included Hyperplastic polyps: PubMed — 59 papers, no RCTs; Cochrane Library — no references; hand searching Comments Professor Finlay Macrae and Professor Jeremy Jass have a cutting-edge, running literature update and continuous engagement with the literature on this topic, active research insights, and Biennial Medline Reviews until September 2004. Additions to the chapter are Section 9.4.2 Other polyposis conditions and Section 9.5 Hyperplastic polyps and polyposis. Chapter 10 — Preparation for surgery Search strategy PubMed and Cochrane Library Literature review 303
Dates 1 January 1998 to June 2004 Search terms Terms searched as per subheading titles of chapters with key words: stoma education and preparation (Section 10.2), bowel preparation (Section 10.3), blood transfusion and colorectal surgery (Section 10.4), thromboembolism prophylaxis and colorectal surgery (Section 10.5), antibiotic prophylaxis and colorectal surgery (Section 10.6). Inclusion/exclusion criteria Articles were excluded if they were not published in English; if found not to be relevant to the subject; if not relevant to Australian practices, for example, medication such as antibiotics not in routine use in Australia; if the full publication was not readily available either online or through library resources. Results Antibiotic prophylaxis and colorectal surgery (retrieved 29 articles — used one); thromboembolism prophylaxis and colorectal surgery (retrieved four articles — used 2); blood transfusion and colorectal surgery (retrieved 11 articles — used one); stomal related (116 RCTs, used one); bowel preparation (retrieved 175, used ten); body temperature (retrieved 22, used one); most studies applied to colonoscopy. Comments If a well conducted meta-analyses or Cochrane review of all relevant literature was available at time of search it was cited in preference to citing all the individual publications. A recent published metaanalysis was available and used to justify the changed guideline. Chapter 11 — Elective surgery for colon cancer Search strategy English publications in PubMed and Cochrane Library Dates Update of 1999 document from 1998–2001, subsequently updated to June 2004. Search terms Colon cancer, surgery, key words from subsection of chapters Inclusion/exclusion criteria Clinical importance, shift in surgical thinking Results There are 42 references in Chapter 11. Of these, 17 were included in the original guidelines, and 19 new references and one personal communication were identified in the initial search as follows: • one meta-analyses (ref 8) • seven randomised trials (25, 26, 27, 29, 30, 31 and 32) • three represented a shift in surgical thinking (6, 21, 24) 304 The prevention, early detection and management of colorectal cancer
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Clinical Practice Guidelines FOR TH
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© The Cancer Council Australia/Aus
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2.11 Conclusions...................
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11.2 High ligation ................
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17.4 Cost effectiveness of follow u
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Table 14.3 Pathological TNM staging
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Executive Summary • Colorectal Ca
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STRENGTH OF RECOMMENDATIONS 2,3 The
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Should red meat intake be altered t
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Chapter Recommendations 4 COMMUNICA
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Chapter 8 Recommendations How shoul
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Chapter Recommendations Should bowe
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Chapter Recommendations When should
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Chapter 17 Recommendations What pos
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Section I Early Colorectal Cancer
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Adenomatous polyps (adenomas) are b
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17. South Australian Cancer Registr
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CHAPTER 2 PRIMARY PREVENTION Studie
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Colorectal adenomas, especially adv
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vegetable (3.5 serves/1000 kcals) d
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mustard greens, swedes and turnips)
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for protection against Colorectal C
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Does selenium supplementation reduc
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the optimal duration of use, and ad
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References 1. Jass JR. Pathogenesis
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34. Kushi L, Giovannucci E. Dietary
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67. Fearon ER, Vogelstein B. A gene
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100. Il'yasova D, Hodgson ME, Marti
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133. Meyskens FL, Jr., Gerner EW. D
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CHAPTER 3 POPULATION SCREENING FOR
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studies also demonstrate that age i
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• symptoms • family medical his
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Should screening be recommended? Gu
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Box 3.3 Screening Pathway used in t
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References 1. Young GP, Levin B, Ro
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33. Alexander F, Weller D. Evaluati
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CHAPTER 4 COMMUNICATION WITH THE PA
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4.6 Coordination of care Treatment
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• assistance with and care of chi
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17. National Breast Cancer Centre,
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CHAPTER 5 THE PATIENT WITH SYMPTOMS
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considered (see 8.1.5). Double cont
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58 The prevention, early detection
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diagnoses prove difficult to confir
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What recommendations are there for
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References 1. Woolf CM. A genetic s
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34. Australian Health Technology Ad
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CHAPTER 7 HIGH-RISK FAMILIAL COLORE
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offered predictive genetic testing.
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endoscopically uncontrollable numbe
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mutation carriers. 52 There is also
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standard for consideration of MSI a
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added to transvaginal ultrasound. 8
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category 2, see Chapter 6) but may
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What screening is recommended for e
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References 1. Vasen HF, Griffioen G
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33. Giardiello FM, Hamilton SR, Kru
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international criteria for the dete
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96. Burt RW, Jass JR. Hyperplastic
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8.1.2 Sigmoidoscopy: rigid versus f
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For radiological imaging of the lar
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8.2.3 Staging for distant metastase
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The feelings and fears of the patie
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18. Rex DK, Cutler CS, Lemmel GT et
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52. Liu SK, Church JM, Lavery IC, F
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strong family history of Colorectal
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A screening interval of 4-6 years i
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BRAF mutation, particularly when mu
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18. Jass JR, Young J, Leggett BA. E
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52. Jass JR, Young J, Leggett BA. H
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What is the role of the stomal ther
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What happens if a blood transfusion
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References 1. Bass EM, Del Pino A,
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32. The National Working Party on t
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CHAPTER 11 ELECTIVE SURGERY FOR COL
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Total or subtotal colectomy may be
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11.12 Self-expanding metal stents f
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18. Gall FP, Tonak J, Altendorf A.
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etween 1993 and 1999. The local rec
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When should local excision of recta
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What factors influence sphincter pr
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It has been demonstrated that there
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References 1. Smith TJ, Hillner BE,
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36. Vernava AM, III, Moran M, Rothe
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69. Pimentel JM, Duarte A, Gregorio
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A clinical diagnosis of large bowel
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When should primary anastomosis be
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17. Deans GT, Krukowski ZH, Irwin S
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Table 14.1 Clinicopathological stag
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The ACPS system embodies the simpli
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14.4 Translation between staging sy
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16. Shepherd NA, Baxter KJ, Love SB
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CHAPTER 15 ADJUVANT CHEMOTHERAPY FO
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isk of death-favouring treatment (H
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improvement in survival at five yea
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There has been one trial 55 of intr
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References 1. National Institute of
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30. Zaniboni A, Labianca R, Marsoni
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57. Gastrointestinal Tumour Study G
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CHAPTER 16 ADJUVANT THERAPY FOR REC
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preoperative RT 45Gy over 5 weeks s
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This suggests that a policy of preo
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Mortality from non-cancer causes wa
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References 1. Fu KK. Interactions o
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29. Swedish Rectal Cancer Trial. Im
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Rates of intraluminal recurrence an
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Ultrasonographic screening Ultrason
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References 1. Nava HR, Pagana TJ. P
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• those with a history of psychia
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References 1. Maisey NR, Norman A,
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CHAPTER 19 RECURRENT AND ADVANCED C
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What are the recommendations for in
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References 1. National Health and M
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31. Phillips RK, Hittinger R, Bleso
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Recurrent and advanced colorectal c
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(23% compared to 12%, p
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more patients having disease down-s
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References 1. Best L, Simmonds P, B
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30. Fuchs CS, Moore MR, Harker G, V
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CHAPTER 21 MANAGEMENT OF LIVER AND
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21.1.3 Imaging controlled destructi
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Does combination systemic chemother
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References 1. Woodington FF, Waugh
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34. Wood BJ, Ramkaransingh JR, Fojo
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66. Headrick JR, Miller DL, Nagorne
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Management of liver and other dista
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years gained can be assessed, which
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‘If neither of the above cases ap
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Study Country Study questions Concl
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Study Country Comparator/ screening
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Study Country Comparator/ screening
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