Clinical Practice Guideline: Colorectal Cancer—Diagnosis, Treatment, Prevention, and Long-Term Follow-Up Care.

BACKGROUND

Approximately 24 000 people die of colorectal cancer (CRC) in Germany each year. New developments in prevention, diagnosis, and treatment are improving long-term outcomes. These measures have been incorporated in the updated guideline and are presented here along with the findings of other new randomized controlled trials (RCTs).

METHODS

A systematic search (2022–2023) was conducted for guidelines, reviews/meta-analyses, and primary studies (search term “colorectal cancer”; databases: international guideline registries, PubMed, Cochrane). 123 reviews were identified, evaluated, and used in the creation of the guideline.

RESULTS

Early detection is performed with colonoscopy every 10 years, sigmoidoscopy every 5 years, or an immunological stool test for occult blood every 1–2 years; it can lower cancer-related mortality by up to 30%. Hereditary forms (Lynch syndrome, polyposis) require more intensive monitoring. All diagnosed cases must be presented to a tumor board. In the case of low-risk pT1 carcinoma, extended resection is not indicated after complete endoscopic removal. In a recent RCT, the recurrence rate was lower after robotic surgery than after laparoscopy (3-year recurrence rate 1.6% and 4.0% respectively; adjusted hazard ratio, 0.39; 95% confidence interval: [0.19; 0.80]). Treatment of patients with mismatch repair deficiency (dMMR) or microsatellite instability-high (MSI-H) cancers with checkpoint inhibitors yields response above 90%. Further systemic therapies are based on the molecular tumor profile (dMMR/MSI-H, RAS, and BRAF). Organ sparing management may be an option for rectal cancer patients in complete remission after neoadjuvant therapy; however, this requires close follow-up monitoring.

CONCLUSION

The efficacy of early detection is undisputed. Less evidence is available concerning the optimal level of intensity of follow-up care. The clinical and molecular stratification of tumors enables differential treatment. Organ-preserving strategies after a complete response to therapy are an important area of current research.