RESUMO
Chronic inflammation of the gastric epithelium has been associated with the pathogenesis of gastric cancer, as it was postulated by Corea's model of gastric carcinogenesis. Helicobacter pylori (Hp) regulates this inflammatory process and promotes gastric carcinogenesis through induction of gene mutations and protein modulation. Recent data raise the cancer stem cell hypothesis, which implies a central role of multipotent cancer cells in oncogenesis of various solid tumors. This review provides a synopsis of gastric cancer initiation and promotion through Hp and stem cell signaling pathways. The expanding research field of Hp-related cancer stem cell biology may offer novel implications for future treatment of upper gastrointestinal cancer.
Assuntos
Infecções por Helicobacter/patologia , Helicobacter pylori , Células-Tronco Neoplásicas/patologia , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologia , Células da Medula Óssea/patologia , Comunicação Celular/fisiologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Humanos , Fatores de Risco , Transdução de Sinais/fisiologia , Neoplasias Gástricas/epidemiologiaRESUMO
BACKGROUND: Upper gastrointestinal endoscopy is the most preferable diagnostic examination for patients over fifty when upper gastrointestinal symptoms appear. However, limited knowledge exists in concerns to the compliance of primary care patients' to the doctors' recommendations for endoscopy. METHODS: Patients who visited primary care practices in Greece and experienced upper gastrointestinal symptoms within a 10 days screening study, were referred for an upper endoscopy exam. The patients which refused to complete the endoscopy exam, were interviewed by the use of an open- ended translated and validated questionnaire, the Identification of Dyspepsia in General Population (IDGP) questionnaire. A qualitative thematic analysis grounded on the theory of planned behavior was performed to reveal the reasons for patients' refusal, while socio-demographic predictors were also assessed. RESULTS: Nine hundred and ninety two patients were recorded, 159 of them (16%) were found positive for dyspepsia and gastro-esophageal reflux disease according to the IDGP questionnaire. Out of the above, 131 (83.6%) patients refused further investigation with endoscopy. Patients who refused upper endoscopy were predominantly female (87.8%) (p = 0.036) and over the age of 50. The lack of severe symptoms, fear of pain, concerns of sedation, comorbidity and competing life demands were reported by patients as barriers to performing an endoscopic investigation. CONCLUSIONS: Patients with dyspepsia in rural Greece tend to avoid upper gastrointestinal endoscopy, with two major axons considered to be the causes of patients' refusal: their beliefs towards endoscopy and their personal capability to cope with it. Future research examining reasons of low compliance should be carried out in combination with modern behavioral theories so as to investigate into the above.
Assuntos
Dispepsia/diagnóstico , Endoscopia Gastrointestinal/psicologia , Refluxo Gastroesofágico/diagnóstico , Cooperação do Paciente/psicologia , Recusa do Paciente ao Tratamento/psicologia , Medo/psicologia , Feminino , Grécia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Inquéritos e QuestionáriosRESUMO
BACKGROUND: This study aimed to investigate the efficacy and safety of placing self-expandable metal stents (SEMSs) without fluoroscopy for palliation of malignant esophageal or esophagogastric strictures. METHODS: From January 2003 to June 2008, a prospective observational study investigated the placement of covered proximal-release Ultraflex stents without fluoroscopy in nonoperable malignant esophageal and esophagogastric strictures. The technical success as well as the early and late complications (perforation, migration, severe gastroesophageal reflux, hematemesis, and reobstruction due to tissue ingrowth or overgrowth) were recorded. Dysphagia before and after stent placement was scored on a 5-point scale. All the patients were observed monthly in the outpatient clinic or by telephone contact until death. RESULTS: The study enrolled 89 patients (16 women; mean age, 69.54±7.1 years) with dysphagia due to inoperable esophageal or esophagogastric malignant strictures (29 squamous cell cancers, 52 adenocarcinomas, and 8 obstructive malignant extrinsic compressions). The mean stricture length was 6.2±2.8 cm. Endoscopic deployment was achieved for 83 patients (93.2%), with accurate stent positioning in all the patients except one. An adequate relief of symptoms was noted for 82 of the patients (92.1%). During the follow-up period, 36 patients (43.4%) had recurrent dysphagia, caused by tumor overgrowth in 32 cases and stent migration in 4 cases, after an average time of 82 days (range 67-216 days). A stent-in-stent procedure was performed in 27 cases. For two patients, a third stent-in-stent needed to be placed after 85 and 216 days, respectively. CONCLUSION: In most cases, SEMSs can be accurately and safely positioned without fluoroscopy for palliative treatment of malignant esophageal dysphagia.
Assuntos
Transtornos de Deglutição/terapia , Neoplasias Esofágicas/terapia , Estenose Esofágica/terapia , Cuidados Paliativos/métodos , Stents , Materiais Revestidos Biocompatíveis , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/complicações , Estenose Esofágica/complicações , Esofagoscopia/métodos , Feminino , Fluoroscopia , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Implantação de Prótese , Qualidade de Vida , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Resultado do TratamentoRESUMO
Pseudoachalasia is a rare clinical entity with clinical, radiographic, and manometric features often indistinguishable from achalasia. Primary adenocarcinomas arising at the gastroesophageal junction or a tumor of the distal esophagus are the most frequent causes of pseudoachalasia. Rarely, processes other than esophagogastric cancers including chronic idiopathic intestinal pseudo-obstruction, amyloidosis, sarcoidosis, Chagas' disease, vagotomy, antireflux surgery, pancreatic pseudocysts, von Recklinghausen's neuroinomatosis, gastrointestinal stromal tumor, and other malignancies and rare genetic syndromes, may lead to the development of pseudoachalasia. Secondary achalasia is extremely rare, with less than 100 cases reported in the literature so far. Gastrointestinal manifestations in primary or secondary amyloidosis include abdominal pain, diarrhea, constipation, malabsorption, obstruction, motility disturbance, intestinal infarction, perforation, and hemorrhage; however, gastrointestinal tract involvement is asymptomatic in most instances. We present here a rare case of multiple myeloma initially presenting with dysphagia because of esophageal amyloidosis and manometric findings typical of achalasia.
Assuntos
Acalasia Esofágica/diagnóstico , Idoso , Amiloidose/complicações , Amiloidose/diagnóstico , Cateterismo , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Acalasia Esofágica/complicações , Acalasia Esofágica/terapia , Doenças do Esôfago/complicações , Doenças do Esôfago/diagnóstico , Evolução Fatal , Feminino , Humanos , Manometria , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/etiologiaRESUMO
Symptomatic esophageal epiphrenic diverticula are usually repaired with diverticulectomy and esophagomyotomy with substantial morbidity and mortality rates, especially in elderly patients. We describe the cases of two elderly patients who had dysphagia caused by large epiphrenic diverticula. Due to severe comorbid diseases, both patients were unable to withstand surgical intervention; botulinum toxin solution was injected endoscopically at multiple sites in the region of the lower esophageal sphincter and esophageal wall near the diverticulum. Symptoms improved immediately and the beneficial effect of botulinum toxin remained for 5-6 months. During the long-term follow-up, the patients developed symptomatic relapses treated by subsequent botulinum toxin solution reinjections resulting in longer-lasting symptom relief.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Transtornos de Deglutição/tratamento farmacológico , Divertículo Esofágico/complicações , Fármacos Neuromusculares/uso terapêutico , Idoso de 80 Anos ou mais , Transtornos de Deglutição/etiologia , Esquema de Medicação , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: EMR traditionally performed by using normal saline solution (NS) plus epinephrine (E) as a submucosal fluid cushion does not maintain the submucosal elevation for a prolonged time. It was hypothesized that 50% dextrose (D(50)) plus E as a hypertonic, inexpensive, and easily available solution might be an ideal alternative for producing and maintaining more-prolonged mucosal elevation. OBJECTIVE: To evaluate D(50)+E versus NS+E during an EMR of sessile rectosigmoid polyps (> 10 mm). DESIGN: A prospective, double-blind, randomized study that compared EMR by using either D(50)+E or NS+E submucosal fluid cushions. SETTING: Four tertiary endoscopic referral centers with 1370 polypectomies in 2006, performed by 5 experienced endoscopists. PATIENTS: Patients treated for sessile rectosigmoid polyps (> 10 mm). INTERVENTIONS: Polypectomy with D(50)+E or NS+E submucosal fluid cushions. MAIN OUTCOME MEASUREMENTS: The duration of submucosal elevation, volume of solution, number of required injections to maintain the elevation, and observations for complications. RESULTS: Ninety-two sessile rectosigmoid polyps were removed. Injected solution volumes and the number of injections to maintain submucosal elevation were lower in the D(50)+E group than in the NS+E group (P = .033 and P = .028, respectively). Submucosal elevation had a longer duration in the D(50)+E group (P = .043). This difference mainly included large (> or = 20 mm) and giant (> 40 mm) polyps. There were 6 and 1 cases of postpolypectomy syndrome in the D(50)+E and NS+E groups, respectively (P = .01). LIMITATIONS: May be limited by inexperienced endoscopist's lack of injection and polypectomy skills. CONCLUSIONS: D(50)+E is superior to NS+E for an EMR, particularly in large and giant sessile polyps, but the risk of thermal tissue injury should be considered.
Assuntos
Pólipos do Colo/cirurgia , Endoscopia Gastrointestinal/métodos , Glucose , Pólipos Intestinais/cirurgia , Doenças Retais/cirurgia , Doenças do Colo Sigmoide/cirurgia , Cloreto de Sódio , Adulto , Idoso , Idoso de 80 Anos ou mais , Pólipos do Colo/patologia , Método Duplo-Cego , Feminino , Humanos , Mucosa Intestinal/fisiologia , Pólipos Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doenças Retais/patologia , Doenças do Colo Sigmoide/patologia , Soluções , Resultado do TratamentoRESUMO
A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy, and total parenteral nutrition (TPN) for 15 d. Seven weeks after cholecystectomy, he presented with cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated extrahepatic filling defects. Despite endoscopic extraction of a biliary cast, cholestasis remained unchanged. Oral administration of ursodeoxycholic acid (UDCA), 750 mg/d, resulted in normalization of liver function tests. We, therefore, propose for the first time, combined endoscopic plus UDCA treatment for the management of biliary cast syndrome.
Assuntos
Colagogos e Coleréticos/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Colangite/tratamento farmacológico , Colangite/cirurgia , Colestase Intra-Hepática/tratamento farmacológico , Colestase Intra-Hepática/cirurgia , Ácido Ursodesoxicólico/uso terapêutico , Idoso , Colecistectomia , Colecistite/cirurgia , Terapia Combinada , Humanos , Masculino , Resultado do TratamentoRESUMO
BACKGROUND: Biliary decompression is a key factor in the treatment of postcholecystectomy bile leak. However, the optimal size of the stent introduced by therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is yet to be determined. The aim of the study was to compare the effectiveness of two straight plastic stents with different sizes (10-Fr and 7-Fr) in the treatment of postcholecystectomy bile leak. METHODS: Between January 2003 and August 2006, 63 patients underwent therapeutic ERCP for postcholecystectomy bile leak. After visualization of the bile duct injury, endoscopic sphincterotomy was performed and the patients were randomized to receive either a 7-Fr (31 subjects, group A) or a 10-Fr (32 subjects, group B) straight plastic stent for four weeks. The success of the endoscopic treatment was determined by the elimination of the symptoms and the removal of the drain without any adverse outcomes. RESULTS: The endoscopic intervention was successful in 29 patients of group A (93.54%) and in 31 patients of group B (96.87%). In the remaining two patients of group A, the 7-Fr stent was substituted by a 10-Fr stent after 7 days because the leak remained unaffected, resulting in healing of the leaks. Surgery was required in the remaining one patient of group B. Eight patients developed post-ERCP pancreatitis (5 mild, 2 moderate, 1 severe), which was treated conservatively. CONCLUSIONS: This trial suggests that the stent size does not affect the outcome of the endoscopic intervention in postcholecystectomy bile leaks due to minor biliary tract injury; however, larger cohorts are required to confirm the optimal stent size in bile leaks due to major bile duct injury.
Assuntos
Fístula Biliar/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/efeitos adversos , Stents , Idoso , Ductos Biliares/fisiopatologia , Fístula Biliar/etiologia , Distribuição de Qui-Quadrado , Colecistectomia Laparoscópica/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Plásticos , Complicações Pós-Operatórias/cirurgia , Probabilidade , Estudos Prospectivos , Desenho de Prótese , Medição de Risco , Resultado do TratamentoRESUMO
BACKGROUND: The use of endoclipping may minimize the risk of bleeding after endoscopic polypectomy of large pedunculated polyps. The aim of this study was to assess the safety and efficacy of endoclipping of the stalk before resection of large pedunculated colorectal polyps, drawing particular attention to the cases in which the use of this method could be very useful. PATIENTS AND METHODS: This retrospective study included 17 patients [10 men, 7 women; median age: 62 y (range 38 to 79)] with 18 large pedunculated colorectal polyps, who underwent endoclipping-assisted endoscopic polypectomy between March 2003 and May 2006. The outcome of the technique and the technique-related complications were evaluated. RESULTS: Application of the clips was possible in all patients. In 4 patients (23.5%), the endoclipping was performed via the more flexible gastroscope. En bloc resection of colon polyps was achieved in all patients. No immediate or late bleeding or perforation occurred. One patient (5.9%) developed postcoagulation syndrome and was successfully treated conservatively. Histologic examination showed in situ carcinoma in 6 polyps (33.3%). Follow-up colonoscopy demonstrated no recurrence of polyps or cancer development. CONCLUSIONS: Endoclipping, followed by snare transection, may be safer than conventional polypectomy in large pedunculated colorectal polyps. Special attention is needed not to cut very close to clips to avoid thermal injury of colonic wall.
Assuntos
Pólipos do Colo/cirurgia , Colonoscopia , Neoplasias Colorretais/cirurgia , Adulto , Idoso , Pólipos do Colo/patologia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Colonic lipoma is a well-documented benign neoplasia, endoscopically appearing as a smooth round yellowish polyp with a thick stalk or broad-based attachment. We describe a 63-year old woman with persistent abdominal pain, in whom colonoscopy revealed a cecal mass with malignant features. Based on the colonoscopy findings, right hemicolectomy was laparoscopically performed for a presumptive diagnosis of a cecal adenocarcinoma, but histological examination revealed a colonic lipoma with overlying mucosal ulceration.
Assuntos
Ceco/patologia , Neoplasias do Colo/patologia , Lipoma/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Neoplasias do Colo/diagnóstico , Colonoscopia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/patologia , Lipoma/diagnóstico , Pessoa de Meia-IdadeRESUMO
A bronchobiliary fistula (BBF) is an uncommon entity with bilioptysis being a pathognomonic sign. We describe the case of a 41-year-old man who had recurrent BBF, 6 months after resection of the anterior segment of the right lower pulmonary lobe and repair of a BBF due to hepatic hydatid disease. Magnetic resonance cholangiography revealed a communication between the biliary tree and the lower lobe of the right lung. Endoscopic biliary sphincterotomy and repeated insertion of large size biliary plastic stents led to a successful resolution of the symptoms and closure of the fistula.
Assuntos
Fístula Biliar/terapia , Fístula Brônquica/terapia , Stents , Adulto , Fístula Biliar/diagnóstico , Fístula Brônquica/diagnóstico , Equinococose Hepática/cirurgia , Equinococose Pulmonar/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Complicações Pós-Operatórias , Recidiva , Esfinterotomia EndoscópicaAssuntos
Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Epistaxe/prevenção & controle , Hemorragia Gastrointestinal/tratamento farmacológico , Telangiectasia Hemorrágica Hereditária/tratamento farmacológico , Idoso , Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Bevacizumab , Endoscopia Gastrointestinal , Epistaxe/etiologia , Feminino , Trato Gastrointestinal/patologia , Humanos , Ferro/administração & dosagem , Fígado/anormalidades , Prevenção Secundária , Telangiectasia Hemorrágica Hereditária/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 92-year-old woman presented with severe acute haemorrhagic gastritis due to abuse of non-steroidal anti-inflammatory drugs (NSAIDs). She was treated with instillation of 150 ml 3% hydrogen peroxide (H2O2) every 2 h via a nasogastric tube. The copious amount of bright red blood through the nasogastric tube started to decline substantially after the first administration of H2O2 and continued to reveal clear material during the second and third instillation of H2O2. The total amount of H2O2 administered was 600 ml. No rebleeding and only a few flame-shaped intramucosal haemorrhages were observed on the following four consecutive daily endoscopic evaluations. These are promising observations which will have to be confirmed with respect to the safety and efficacy of H2O2 treatment by further controlled studies.
Assuntos
Hemostáticos/uso terapêutico , Peróxido de Hidrogênio/uso terapêutico , Úlcera Péptica Hemorrágica/tratamento farmacológico , Úlcera Gástrica/complicações , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/efeitos adversos , Feminino , Gastrite/induzido quimicamente , Gastrite/complicações , Técnicas Hemostáticas , Humanos , Úlcera Péptica Hemorrágica/etiologia , Úlcera Gástrica/induzido quimicamenteRESUMO
BACKGROUND: Hemorrhoidopexy using the circumferential stapler is an established method for surgical treatment of patients with prolapsing hemorrhoids. Despite its advantages, complications such as anal canal stenosis, hemorrhage and anastomosis leak with eventual intrapelvic sepsis can cause serious postoperative problems. The aim of this study was to evaluate the utility of a surgical adhesive, the biological albumin-glutaraldehyde glue "Bioglue", in reduction of these postoperative complications. PATIENTS AND METHODS: Between January 2002 and November 2004, 200 patients undergoing stapled hemorrhoidopexy were enrolled in a prospective, randomized clinical trial. One hundred patients were randomly assigned to the control group; the study group consisted of 100 patients who received Bioglue in the mucosa anastomosis area. All patients received standardized postoperative analgesic, laxative and antibiotic treatment. We then evaluated the two groups for postoperative complications (after surgery and 6 months postoperatively). RESULTS: From the control group (no Bioglue application), two patients presented with anal stenosis, two with hemorrhage, three had anastomosis leak and one had thrombosis, whereas none of the patients from the Bioglue group had any of these complications. Both groups had patients with severe postoperative pain (3 each) and fecal incontinence (1 patient each). The overall difference in the number of complications in the two groups was statistically significant (p < 0.05). CONCLUSION: In this first study using Bioglue in patients undergoing circumferential stapled hemorrhoidopexy we have shown that application of the glue is effective in reducing postoperative complications.
Assuntos
Hemorroidas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Proteínas , Grampeadores Cirúrgicos , Adesivos Teciduais , Distribuição de Qui-Quadrado , Incontinência Fecal/prevenção & controle , Feminino , Seguimentos , Humanos , Mucosa Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Fatores de TempoRESUMO
We report a case of a 30-year-old man who presented with severe debilitation, anemia and diarrhea over two months. Colonoscopy revealed many (>100) polyps (familial adenomatous polyposis syndrome). Abdominal CT scan showed a large mass at the left upper abdomen in conjunction with the splenic flexure. Total colectomy with mesenteric mass and adjacent small bowel removal and ileoanal pouch was performed. Examination of the resected mesenteric mass showed a gastrointestinal stromal tumor (GIST) with scarce mitosis and infiltration of the adjacent small bowel. We describe for the first time in medical literature the coexistence of familial adenomatous polyposis syndrome and GIST in a 30-year-old man.
Assuntos
Polipose Adenomatosa do Colo/complicações , Polipose Adenomatosa do Colo/diagnóstico , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/diagnóstico , Mesentério/patologia , Adulto , Humanos , Masculino , Doenças Raras/diagnóstico , SíndromeRESUMO
Colorectal cancer remains a major cause of cancer mortality in the Western world both in men and women. In this manuscript a concise overview and recommendations on adjuvant chemotherapy in colon cancer are presented. An executive team from the Hellenic Society of Medical Oncology was assigned to develop a consensus statement and guidelines on the adjuvant treatment of colon cancer. Fourteen statements on adjuvant treatment were subjected to the Delphi methodology. Voting experts were 68. All statements achieved a rate of consensus above than 80% (>87%) and none revised and entered to a second round of voting. Three and 8 of them achieved a 100 and an over than 90% consensus, respectively. These statements describe evaluations of therapies in clinical practice. They could be considered as general guidelines based on best available evidence for assistance in treatment decision-making. Furthermore, they serve to identify questions and targets for further research and the settings in which investigational therapy could be considered.
RESUMO
Despite considerable improvement in the management of colon cancer, there is a great deal of variation in the outcomes among European countries, and in particular among different hospital centers in Greece and Cyprus. Discrepancy in the approach strategies and lack of adherence to guidelines for the management of colon cancer may explain the situation. The aim was to elaborate a consensus on the multidisciplinary management of colon cancer, based on European guidelines (ESMO and EURECCA), and also taking into account local special characteristics of our healthcare system. Following discussion and online communication among members of an executive team, a consensus was developed. Statements entered the Delphi voting system on two rounds to achieve consensus by multidisciplinary international experts. Statements with an agreement rate of ≥80% achieved a large consensus, while those with an agreement rate of 60-80% a moderate consensus. Statements achieving an agreement of <60% after both rounds were rejected and not presented. Sixty statements on the management of colon cancer were subjected to the Delphi methodology. Voting experts were 109. The median rate of abstain per statement was 10% (range: 0-41%). In the end of the voting process, all statements achieved a consensus by more than 80% of the experts. A consensus on the management of colon cancer was developed by applying the Delphi methodology. Guidelines are proposed along with algorithms of diagnosis and treatment. The importance of centralization, care by a multidisciplinary team, and adherence to guidelines is emphasized.
RESUMO
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.
RESUMO
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.