Colon Cancer Clinical Practice Guidelines (ASCRS, 2022)

American Society of Colon and Rectal Surgeons

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

March 02, 2022

Updated guidelines on the management of colon cancer were published on February 1, 2022 by the American Society of Colon and Rectal Surgeons (ASCRS), in Diseases of the Colon & Rectum.[1]

In patients with locally advanced colon cancer, neoadjuvant chemotherapy or radiotherapy can result in tumor regression and may facilitate margin-negative excision of locally advanced cancers.

In patients with initially resectable colon cancer liver metastasis, an individualized decision should be made on neoadjuvant chemotherapy followed by surgical resection or up-front surgery.

Patients with initially unresectable colon cancer liver metastasis should be considered for neoadjuvant chemotherapy to attempt to convert to resectability.

Hepatic artery infusion of chemotherapy combined with systemic chemotherapy or immunotherapy may increase resectability of colon cancer liver metastasis, but should be performed only in centers with the appropriate expertise.

In patients with colon cancer and resectable liver metastasis, a single "combined" operation is generally recommended for relatively low complexity operations and sequential or "staged" operations are generally recommended for higher complexity cases.

In patients with resectable colon cancer lung metastasis, resection of the lung lesions should be considered as it may prolong survival.

In patients with stage IV (deficient mismatch repair [dMMR] or high microsatellite instability [MSI-H]) colon cancer, immunotherapy with antibody to programmed death ligand 1 (PD-L1) or PD-1 should be considered.

In general, and if possible, adjuvant chemotherapy should be started within 8 weeks of colon resection.

The use of multigene assays, CDX2 expression analysis, and circulating tumor DNA (ctDNA) may be used to complement multidisciplinary decision-making for patients with stage II or III colon cancer.

For more information, please go to Colon Cancer.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.