Standardizing the Definition of Each Colon Cancer Segment: Delphi Consensus on Clinical Decision-Making for Oncologic Outcomes

Kuzu MA, Benlice C, Parvaiz A, Gorgun E, Bertelsen CA, Wexner S, Dozois EJ, Hohenberger W, Miskovic D, Sugihara K, Spinelli A, Wiggers T, Lee WY, Möslein G, Tsarkov P, Basany EE, Uriburu JCP, Perez RO, Lynch C, Liu Z, Hahnloser D, Nilsson PJ, Chowdri NA, Brown G, Rouanet P, Madoff RD, West NP, Sahin T, Elhan AH, Bordeianou LG (2025)

Publication Type: Journal article

Publication year: 2025

Journal

DOI: 10.1097/DCR.0000000000003739

Abstract

BACKGROUND: Data registries lack a definitive classification system that distinguishes different locations of colon cancer from one another. OBJECTIVE: To establish an international consensus on the definition of primary colon cancer segment locations. DESIGN: Between December 2022 and June 2023, Delphi survey study was conducted to seek opinions from relevant international experts and eventually develop a consensus definition of each colon cancer segment. SETTING: Three-round online-based Delphi survey study. INTERVENTIONS: Online survey included 17 questions. In the first two rounds, participating experts were asked to rank each statement on a scale of 1-9 (9 is the most relevant). Consensus statements and definitions were revised according to results, obtaining a consensus score of 7-9. During the third round and online meeting, definitions and statements reached a moderate or high consensus(above 4 in more than 70% of participants) were included. MAIN OUTCOME AND MEASURE: Primary goal of our project was focused on precisely localizing the specific segment affected by primary colon cancer, rather than to identify surgical treatment or type of resection needed for particular segment. RESULTS: The first round included 331 experts, 301 (91%) completed the second round, and 295 (98%) completed the final round. Experts strongly supported the use of a “10 cm rule” to describe colon cancer sites at the flexures and anatomical landmarks for other segments. Regarding the definition of rectosigmoid cancer, experts from America and Europe reached a high consensus that the term rectosigmoid as a colon cancer location must be abolished in contrast to experts from Asia. Description of cancers overlapping segments achieved a consensus of 64%. LIMITATIONS: Subjective decisions are based on individual expert clinical experience. CONCLUSIONS: This Delphi survey, the first internationally conducted consensus study, achieved a remarkable level of consensus among a panel of global experts. Ambiguity still exists regarding overlapping lesions.

Authors with CRIS profile

Involved external institutions

Karolinska University Hospital / Karolinska Universitetssjukhuset Sweden (SE) Institut de Recherche en Cancérologie de Montpellier (IRCM) France (FR) Imperial College London / The Imperial College of Science, Technology and Medicine United Kingdom (GB) University of Leeds United Kingdom (GB) Sungkyunkwan University (SKKU) Korea, Republic of (KR) Hospital Alemão Oswaldo Cruz Brazil (BR) Cankiri State Hospital / Çankırı Devlet Hastanesi Turkey (TR) Humanitas University Italy (IT) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Cleveland Clinic United States (USA) (US) Peking Union Medical College Hospital (PUMCH) / Beijing Xiehe Hospital China (CN) Pirogov Russian National Research Medical University (RSMU / RNRMU) Russian Federation (RU) Sher-i-Kashmir Institute of Medical Sciences (SKIMS) / شیرِ کشمیر انسٹیچیوٹ آف میڈیکل سائنسز India (IN) Ankara University / Ankara Üniversitesi Turkey (TR) Harvard University United States (USA) (US) Mayo Clinic United States (USA) (US) Institute of Science Tokyo (ISCT) / 東京科学大学 Japan (JP) Sydney Adventist Hospital Australia (AU) University of Minnesota (UMN) United States (USA) (US) Hospital Británico de Buenos Aires / Buenos Aires British Hospital Argentina (AR) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen Netherlands (NL) St. Mark's Hospital United Kingdom (GB) Copenhagen University Hospital Denmark (DK) Champalimaud Foundation / Fundação Champalimaud Portugal (PT)

How to cite

APA:

Kuzu, M.A., Benlice, C., Parvaiz, A., Gorgun, E., Bertelsen, C.A., Wexner, S.,... Bordeianou, L.G. (2025). Standardizing the Definition of Each Colon Cancer Segment: Delphi Consensus on Clinical Decision-Making for Oncologic Outcomes. Diseases of the colon & rectum. https://doi.org/10.1097/DCR.0000000000003739

MLA:

Kuzu, Mehmet Ayhan, et al. "Standardizing the Definition of Each Colon Cancer Segment: Delphi Consensus on Clinical Decision-Making for Oncologic Outcomes." Diseases of the colon & rectum (2025).

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