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

    Mehmet Ayhan Kuzu,Cigdem Benlice， Liliana G Bordeianou, Colon Cancer Delphi Consensus Study Group

    Diseases of the colon and rectum（2025）

    Department of General Surgery | Champalimaud Cancer Foundation | Department of Surgery | Division of Colorectal Surgery | Division of Colon and Rectal Surgery | Universitatsklinikum Erlangen | Consultant Colorectal Surgeon | Tokyo Medical and Dental University | Samsung Medical Center | Director | First Moscow State Medical University | Head of the Coloproctology Service. British Hospital of Buenos Aires | Hospital Alemão Oswaldo Cruz | Sydney Adventist Hospital | University Hospital Lausanne | Dept. of Pelvic Cancer | Professor of Gastrointestinal Cancer Imaging | Montpellier Cancer Institute | Pathology and Data Analytics | Cankiri State Hospital | Department of Biostatistics

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    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, the 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:The online survey included 17 questions. In the first 2 rounds, participating experts were asked to rank each statement on a scale of 1 (least relevant) to 9 (most relevant). Consensus statements and definitions were revised according to the results for statements obtaining a consensus score of 7 to 9. During the third round and online meeting, definitions and statements that reached a moderate or high consensus (above 4 for more than 70% of participants) were included. MAIN OUTCOME MEASURES:The primary goal of our project was focused on precisely localizing the specific segment affected by primary colon cancer rather than identifying surgical treatment or type of resection needed for a 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 United States and Europe reached a high consensus that the term rectosigmoid as a colon cancer location must be abolished in contrast to experts from Asia. The description of overlapping segments of cancers 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 . ESTANDARIZACIN DE LA DEFINICIN DE CADA SEGMENTO DE CNCER DE COLON CONSENSO DELPHI SOBRE LA TOMA DE DECISIONES CLNICAS PARA RESULTADOS ONCOLGICOS:ANTECEDENTES:Las bases de datos carecen de un sistema de clasificación definitivo que distinga las diferentes localizaciones del cáncer de colon.OBJETIVO:Establecer un consenso internacional sobre la definición de las localizaciones de los segmentos del cáncer de colon priamrio.DISEÑO:Entre diciembre de 2022 y junio de 2023, se realizó un estudio Delphi para recabar la opinión de expertos internacionales relevantes y, finalmente, desarrollar una definición consensuada de cada segmento del cáncer de colon.ESCENARIO:Estudio Delphi en línea de 3 rondas.INTERVENCIONES:La encuesta en línea incluyó 17 preguntas. En las dos primeras rondas, se pidió a los expertos participantes que calificaran cada afirmación en una escala del 1 al 9 (9 es la más relevante). Las afirmaciones y definiciones de consenso se revisaron según los resultados, obteniendo una puntuación de consenso de 7 a 9. Durante la tercera ronda y la reunión en línea, se incluyeron las definiciones y afirmaciones que alcanzaron un consenso moderado o alto (superior a 4 en más del 70 % de los participantes).MEDIDA PRINCIPALES DE RESULTADOS:El objetivo principal de nuestro proyecto se centró en localizar con precisión el segmento específico afectado por el cáncer de colon primario, en lugar de identificar el tratamiento quirúrgico o el tipo de resección necesario para un segmento en particular.RESULTADOS:La primera ronda incluyó a 331 expertos, 301 (91%) completaron la segunda ronda y 295 (98%) completaron la ronda final. Los expertos apoyaron firmemente el uso de una "regla de 10 cm" para describir las localizaciones del cáncer de colon en las flexuras y puntos de referencia anatómicos para otros segmentos. En cuanto a la definición de cáncer rectosigmoideo, expertos de América y Europa alcanzaron un alto consenso en la necesidad de abolir el término "rectosigmoide" como localización del cáncer de colon, a diferencia de los expertos de Asia. La descripción de los cánceres en segmentos que se superponen a alcanzó un consenso del 64%.LIMITACIONES:Las decisiones subjetivas se basan en la experiencia clínica individual de cada experto.CONCLUSIONES:Esta encuesta Delphi, el primer estudio de consenso realizado a nivel internacional, alcanzó un notable nivel de consenso entre un panel de expertos globales. Todavía existe ambigüedad en cuanto a las lesiones superpuestas. (Traducción-Dr. Jorge Silva Velazco ).
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    【要点】：该研究通过德尔菲法建立了国际共识，对原发性结肠癌各段位置的定义进行了标准化，以提高临床决策的精确性。
    

    【方法】：研究采用三轮在线德尔菲调查，收集相关国际专家的意见，并对共识声明和定义进行修订。
    

    【实验】：在三轮调查中，共有331位专家参与第一轮，301位完成第二轮，295位完成第三轮。最终，专家们对使用“10厘米规则”描述结肠癌位置以及取消“直肠乙状结肠”作为位置术语达成共识。实验使用的数据集为参与专家的临床经验，结果在描述重叠段癌症时达成了64%的共识。