Guideline

. 2018 Feb;23(1):1-34.

doi: 10.1007/s10147-017-1101-6. Epub 2017 Mar 27.

Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer

Toshiaki Watanabe¹, Kei Muro², Yoichi Ajioka³, Yojiro Hashiguchi⁴, Yoshinori Ito⁵, Yutaka Saito⁶, Tetsuya Hamaguchi⁷, Hideyuki Ishida⁸, Megumi Ishiguro⁹, Soichiro Ishihara¹⁰, Yukihide Kanemitsu¹¹, Hiroshi Kawano¹², Yusuke Kinugasa¹³, Norihiro Kokudo¹⁴, Keiko Murofushi¹⁵, Takako Nakajima¹⁶, Shiro Oka¹⁷, Yoshiharu Sakai¹⁸, Akihito Tsuji¹⁹, Keisuke Uehara²⁰, Hideki Ueno²¹, Kentaro Yamazaki²², Masahiro Yoshida²³, Takayuki Yoshino²⁴, Narikazu Boku⁷, Takahiro Fujimori²⁵, Michio Itabashi²⁶, Nobuo Koinuma²⁷, Takayuki Morita²⁸, Genichi Nishimura²⁹, Yuh Sakata³⁰, Yasuhiro Shimada³¹, Keiichi Takahashi³², Shinji Tanaka³³, Osamu Tsuruta³⁴, Toshiharu Yamaguchi³⁵, Naohiko Yamaguchi³⁶, Toshiaki Tanaka¹⁰, Kenjiro Kotake³⁷, Kenichi Sugihara^{9

38}; Japanese Society for Cancer of the Colon and Rectum

Affiliations

¹ Department of Surgical Oncology, The Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. toshwatanabe@yahoo.co.jp.
² Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
³ Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
⁴ Department of Surgery, Teikyo University, Tokyo, Japan.
⁵ Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
⁶ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
⁷ Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
⁸ Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
⁹ Department of Translational Oncology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
¹⁰ Department of Surgical Oncology, The Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
¹¹ Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
¹² Department of Gastroenterology, St. Mary's Hospital, Fukuoka, Japan.
¹³ Department of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
¹⁴ Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
¹⁵ Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁶ Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.
¹⁷ Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
¹⁸ Department of Surgery, Kyoto University, Kyoto, Japan.
¹⁹ Department of Clinical Oncology, Faculty of Medicine, Kagawa University, Takamatsu, Japan.
²⁰ Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
²¹ Department of Surgery, National Defense Medical College, Saitama, Japan.
²² Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
²³ Department of Hemodialysis and Surgery, Chemotherapy Research Institute, International University of Health and Welfare, Ichikawa, Japan.
²⁴ Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan.
²⁵ Diagnostic Pathology Center, Shinko Hospital, Kobe, Japan.
²⁶ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
²⁷ Department of Health Administration and Policy, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
²⁸ Department of Surgery, Cancer Center, Aomori Prefectural Central Hospital, Aomori, Japan.
²⁹ Department of Surgery, Japanese Red Cross Kanazawa Hospital, Ishikawa, Japan.
³⁰ CEO, Misawa City Hospital, Misawa, Japan.
³¹ Division of Clinical Oncolgy, Kochi Health Sciences Center, Kochi, Japan.
³² Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
³³ Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
³⁴ Division of GI Endoscopy, Kurume University School of Medicine, Fukuoka, Japan.
³⁵ Department of Gastroenterological Surgery, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
³⁶ Library of SEIREI SAKURA Citizen Hospital, Sakura, Japan.
³⁷ Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
³⁸ Koujinkai Daiichi Hospital, Tokyo, Japan.

PMID: 28349281
PMCID: PMC5809573
DOI: 10.1007/s10147-017-1101-6

Guideline

Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer

Toshiaki Watanabe et al. Int J Clin Oncol. 2018 Feb.

. 2018 Feb;23(1):1-34.

doi: 10.1007/s10147-017-1101-6. Epub 2017 Mar 27.

Authors

Affiliations

¹ Department of Surgical Oncology, The Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. toshwatanabe@yahoo.co.jp.
² Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
³ Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
⁴ Department of Surgery, Teikyo University, Tokyo, Japan.
⁵ Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
⁶ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
⁷ Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
⁸ Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
⁹ Department of Translational Oncology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
¹⁰ Department of Surgical Oncology, The Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
¹¹ Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
¹² Department of Gastroenterology, St. Mary's Hospital, Fukuoka, Japan.
¹³ Department of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
¹⁴ Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
¹⁵ Radiation Oncology Department, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁶ Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.
¹⁷ Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
¹⁸ Department of Surgery, Kyoto University, Kyoto, Japan.
¹⁹ Department of Clinical Oncology, Faculty of Medicine, Kagawa University, Takamatsu, Japan.
²⁰ Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
²¹ Department of Surgery, National Defense Medical College, Saitama, Japan.
²² Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
²³ Department of Hemodialysis and Surgery, Chemotherapy Research Institute, International University of Health and Welfare, Ichikawa, Japan.
²⁴ Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan.
²⁵ Diagnostic Pathology Center, Shinko Hospital, Kobe, Japan.
²⁶ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
²⁷ Department of Health Administration and Policy, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
²⁸ Department of Surgery, Cancer Center, Aomori Prefectural Central Hospital, Aomori, Japan.
²⁹ Department of Surgery, Japanese Red Cross Kanazawa Hospital, Ishikawa, Japan.
³⁰ CEO, Misawa City Hospital, Misawa, Japan.
³¹ Division of Clinical Oncolgy, Kochi Health Sciences Center, Kochi, Japan.
³² Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
³³ Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
³⁴ Division of GI Endoscopy, Kurume University School of Medicine, Fukuoka, Japan.
³⁵ Department of Gastroenterological Surgery, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
³⁶ Library of SEIREI SAKURA Citizen Hospital, Sakura, Japan.
³⁷ Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
³⁸ Koujinkai Daiichi Hospital, Tokyo, Japan.

PMID: 28349281
PMCID: PMC5809573
DOI: 10.1007/s10147-017-1101-6

Abstract

Japanese mortality due to colorectal cancer is on the rise, surpassing 49,000 in 2015. Many new treatment methods have been developed during recent decades. The Japanese Society for Cancer of the Colon and Rectum Guidelines 2016 for the treatment of colorectal cancer (JSCCR Guidelines 2016) were prepared to show standard treatment strategies for colorectal cancer, to eliminate disparities among institutions in terms of treatment, to eliminate unnecessary treatment and insufficient treatment, and to deepen mutual understanding between health-care professionals and patients by making these Guidelines available to the general public. These Guidelines were prepared by consensus reached by the JSCCR Guideline Committee, based on a careful review of the evidence retrieved by literature searches, and in view of the medical health insurance system and actual clinical practice settings in Japan. Therefore, these Guidelines can be used as a tool for treating colorectal cancer in actual clinical practice settings. More specifically, they can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient. As a result of the discussions held by the Guideline Committee, controversial issues were selected as Clinical Questions, and recommendations were made. Each recommendation is accompanied by a classification of the evidence and a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here we present the English version of the JSCCR Guidelines 2016.

Keywords: Chemotherapy; Colorectal cancer; Endoscopy; Guideline; Radiotherapy; Surgery.

PubMed Disclaimer

Conflict of interest statement

Funding

Preparation of these Guidelines was funded by the JSCCR. No financial support was received from any other organization or corporation.

Conflict of interest

The following corporations were disclosed by self-declaration of the Guideline Committee members and Guideline Evaluation Committee members.Asahi Kasei Medical Co., Ltd., Ajinomoto Pharmaceuticals Co., Ltd., AstraZeneca K.K., Astellas Pharma Inc., Eisai Co., Ltd., MSD K.K., Otsuka Pharmaceutical Co., Ltd., Ono pharmaceutical Co., Ltd., Olympus Corporation, JIMRO Co., Ltd., 3-D Matrix, Ltd., Yakult Honsha Co., Ltd., Quintiles Transnational Japan K.K., Glaxo-SmithKline K.K., Kyowa Hakko Kirin Co., Ltd., Sanofi Inc., Shionogi & Co., Ltd., Johnson & Johnson, ZERIA Pharmaceutical Co.,Ltd., Daiichi-Sankyo Company, Limited, Sumitomo Dainippon Pharma Co., Ltd., Taiho pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited., Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical Co., Ltd., Toyama Chemical Co., Ltd., Eli Lilly Japan, Nihon Pharmaceutical Co., Ltd., Boehringer Ingelheim Japan, Novartis Pharma K.K., Pfizer Inc., Merck Serono Co., Ltd., Janssen Pharmaceutical K.K. Measures for the conflicts of interestThe Guideline Committee and the Guideline Evaluation Committee have been organized in members with a diverse range of disciplines, including surgery, internal medicine, radiology, pathology, etc., in order to minimize biased opinion. Each recommendation was determined not on an individual opinion basis but based on voting by the whole committee members, with consensus prioritized.

Figures

**Fig. 1**
Treatment strategies for cTis (M) cancer and cT1 (SM) cancer

**Fig. 2**
Surgical treatment strategies for cStage 0 to cStage III colorectal cancer

**Fig. 3**
Treatment strategies for Stage IV colorectal cancer

**Fig. 4**
Treatment strategies for recurrent colorectal cancer

**Fig. 5**
Treatment strategies for hematogenous metastases

**Fig. 6**
Chemotherapy for unresectable colorectal cancer

**Fig. 7**
An example of a surveillance schedule after curative resection of pStage I to pStage III colorectal cancer

**Fig. 8**
Graph of the cumulative incidence of recurrence according to stage (project study by the JSCCR: patients in years 1991–1996)

**Fig. 9**
Graph of the cumulative incidence of recurrence according to the site of recurrence (project study by the JSCCR: patients in years 1991–1996)

**Fig. 10**
Treatment strategies for pT1 (SM) cancer after endoscopic resection

**Fig. 11**
Method for measuring depth of SM invasion. a When it is possible to identify or estimate the location of the muscularis mucosae, depth of SM invasion is measured from the lower border of the muscularis mucosae. b, c When it is not possible to identify or estimate the location of the muscularis mucosae, depth of SM invasion is measured from the surface layer of the muscularis mucosae. Sessile lesion (b), Pedunculated lesion (c). d For pedunculated lesions with tangled a muscularis mucosae, depth of SM invasion is measured as the distance between the point of deepest invasion and the reference line, which is defined as the boundary between the tumor head and the stalk. e Invasion by pedunculated lesions that is limited to within the head is defined as “head invasion”

**Fig. 12**
Venous invasion (*arrow* in A). A Located in the vicinity of an artery (a). B Elastic fibers in the vein wall have become clear by Victoria blue staining

**Fig. 13**
Lymphatic invasion (*arrow* in a). a A cancer cell nest is visible in the interstitial space. b Double staining for cytokeratin and D2-40. Cancer cells are stained *brown*, and the lymphatic endothelium is stained *purplish red*

**Fig. 14**
Space formed by artifacts during preparation of the specimen (*arrow* in a). a A cancer cell nest is visible in the interstitial space. b Double staining for cytokeratin and D2-40. The interstitial space is D2-40-negative

**Fig. 15**
Budding (*arrow* in b). A cancer cell nest consisting of one or fewer than five cells that has infiltrated the interstitium at the invasive margin of the cancer is seen. b is the square area in a

See this image and copyright information in PMC

References

1. Japanese Society for Cancer of the Colon and Rectum (2016) JSCCR Guidelines 2016 for the Treatment of Colorectal Cancer. Kanehara & Co.Ltd, Tokyo
1. Fukui T, Yamaguchi N, Morizane T (2014) Minds handbook for clinical practice guideline development 2014. Igaku Shoin, Tokyo
1. Aihara M, Mihara H, Murayama T (2010) GRADE system for clinical practice guideline—therapeutic intervention. Toppan Media, Hirosaki
1. Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res. 2004;4:38. doi: 10.1186/1472-6963-4-38. - DOI - PMC - PubMed
1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926. doi: 10.1136/bmj.39489.470347.AD. - DOI - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer

Affiliations

Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer

Authors

Affiliations

Abstract

Conflict of interest statement

Funding

Conflict of interest

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials