Taiwan Society of Colon and Rectal Surgeons (TSCRS) Consensus for Cytoreduction Selection in Metastatic Colorectal Cancer

Background Taiwan has witnessed a surge in the incidence of colorectal cancer (CRC), of which 40-60% metastasize. Continuous updating of cytoreductive strategies in metastatic CRC (mCRC) has contributed to median overall survival reaching 40 months. In this changing scenario, to standardize the approaches across Taiwan, a group of experts from the Taiwan Society of Colon and Rectal Surgeons (TSCRS) convened to establish evidence- and opinion-based recommendations for defining the criteria of resectability in mCRC. Methods Over the course of one-on-one consultations, lasting 30-40 min each, with 30 medical specialists (19 colorectal surgeons, 4 general surgeons, and 7 medical oncologists) from 16 hospitals in Taiwan followed by a 2-h meeting with 8 physician experts (3 general surgeons, 4 colorectal surgeons, and 1 thoracic surgeon), 12 key questions on cytoreduction were addressed. This was further contextualized based on published literature. Results The final consensus includes eight recommendations regarding the criteria for metastasis resection, role of local control treatment in liver potentially resectable patients, management of synchronous liver metastases, approach for peritoneal metastasis, place for resection in multiple-organ metastasis, and general criteria for resectability. Conclusions mCRC patients undergoing R0 resection have the greatest survival advantage following surgery. Our role as a multidisciplinary team (MDT) should be to treat potentially resectable mCRC patients as rapidly and safely as possible, and achieve R0 resection as far as possible and for as long as possible (continuum of care). This TSCRS consensus statement aims to help build clinical capacity within the MDTs, while making better use of existing healthcare resources.

Automated summary

Taiwan has seen a rise in colorectal cancer cases, with 40-60% of them metastasizing. Continuous updating of cytoreductive strategies in metastatic CRC has improved overall survival to 40 months. A group of experts from TSCRS in Taiwan established evidence-based recommendations for defining resectability criteria in mCRC through consultations and discussions. The final consensus includes eight recommendations regarding metastasis resection criteria, local control treatment in liver resectable patients, synchronous liver metastases management, peritoneal metastasis approach, resection in multiple-organ metastasis, and general resectability criteria. Patients undergoing R0 resection have the greatest survival advantage, and MDTs play a key role in providing rapid and safe treatment. The TSCRS consensus statement aims to enhance clinical capacity within MDTs and optimize healthcare resources.