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• seven were papers on new subjects: refs 9, 10, 11 on omental wrapping of anastomoses; refs 34, 35, 36, 37 on metal stents for obstructing cancer • one paper — the most up to date Australian paper on a subject where no local paper has been published (ref 28) • one personal communication from the coordinator of the Australian randomised trial comparing open and laparoscopic colectomy — the work is unpublished as the trial is not complete. In a further literature review in June 2004, a review of the Cochrane Library revealed eight randomised controlled studies. These were considered, but did not add substantially to the manuscript as five included chemotherapeutic approaches (Chapter 15), one referred to antibiotic and chemoprevention of wound infection (Chapter 10), and one to surgical volume and outcome (Chapter 12). References 33, 34 and 35 were added to Section 11.11, stressing the current status of laparoscopic colectomy. Chapter 12 — Elective surgery for rectal cancer Search strategy PubMed, Ovid and Cochrane Library Dates Updated 1999 document from 1980 to 2002, and further updated to June 2004 Search terms Rectal, rectal cancer, surgery Inclusion/exclusion criteria Clinical importance, rigour of methods and statistical analyses, strength of trial Results Following revision to 2002, a subsequent review of Cochrane Library, PubMed and EBMR was carried out on publications to June 2004. Of the 113 articles retrieved, five RCTs were included in the chapter. The others were not relevant to Chapter 12 and were considered in Chapters 15, 16 and 19. Comments The original document was reviewed, the references checked and updated to current practice. The references used in the articles were further examined for other related articles that may have been missed in the initial search. This review was extensive and thorough and carefully considered. Data that were flawed in a material way on the basis of methodology, exclusions, analysis, etc. were not used. A large amount of the reference material was not directed at surgery in a ‘pure’ sense; it was also directed at chemotherapy and radiotherapy and so was not relevant in the context of this chapter as these data are covered in Chapters 16 and 19. Chapter 13 — Emergency surgery Search strategy Cochrane databases, PubMed Literature review 305
Dates Update of 1999 document from 1 January 1993 – 1 June 2004 Search terms Colon cancer, rectal cancer, surgery, emergency Inclusion/exclusion criteria Excluded five foreign language papers and non-RCTs. There is no RCT of treatment versus no treatment. Results Search titles: PubMed — ten non-RCT citations, two RCTs (refs 22 and 15); the bona-fides of 15 RCTs are questioned in a Cochrane review by De Salvo et al (ref 16) that refers only to left-sided Colorectal Cancer. Primary resection is standard practice for right colon obstruction; there are no RCTs. Surgeons in Australia prefer primary resection for obstruction of both right colon and left colon. Current practice does not change on basis of no RCTs. There is no recommendation when there are no trials, merely advice to consider an approach based on observation. Cochrane review considers that this treatment ‘has not yet been established as being more effective than a two stage procedure in patients with obstruction from primary left colon carcinoma’. 1 The lack of RCTs or favoured RCTs should not stop good things being done. Expert opinion is based on evidence level and strength of recommendation. Comments This chapter addresses clinical problems of patients with Colorectal Cancer who are in acute difficulty. The area addressed is quite deficient on randomised clinical trials. It is considered in Cochrane review that the variables involved in clinical circumstances render an RCT approach very difficult. Cross-referencing to Chapter 10 is extensive Chapter 14 — Clinicopathological staging and reporting Search strategy Cochrane Library, EBMR, Ovid, MD Consult, BMJ Clinical Evidence, PubMed. Dates Update of 1999 document. January 1998 – June 2004 Search terms Clinicopathological staging, colon cancer, Colorectal Cancer, rectal cancer Inclusion/exclusion criteria Reference to the parameters of clinicopathological correlation with prognosis Results Two Cochrane systematic reviews and nine RCTs. One RCT not relevant. Hand searching, no further yield. 306 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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Page 288 and 289: Study Country Comparator/ screening
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Page 341 and 342: Search terms MeSH terms were ‘col
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Page 347 and 348: However, in some cases it was also
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Page 361 and 362: TNM tumour, node, metastasis stagin
Page 363 and 364: Chemotherapy The use of drugs (whic
Page 365 and 366: Malignant Cancerous Malignant cells
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