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

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. See Video Abstract.