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Practice Guideline
. 2023 Mar;21(3):581-603.e33.
doi: 10.1016/j.cgh.2022.12.006. Epub 2022 Dec 20.

Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

Giulia Martina Cavestro  1 , Alessandro Mannucci  2 , Francesc Balaguer  3 , Heather Hampel  4 , Sonia S Kupfer  5 , Alessandro Repici  6 , Andrea Sartore-Bianchi  7 , Toni T Seppälä  8 , Vincenzo Valentini  9 , Clement Richard Boland  10 , Randall E Brand  11 , Tineke E Buffart  12 , Carol A Burke  13 , Riccardo Caccialanza  14 , Renato Cannizzaro  15 , Stefano Cascinu  16 , Andrea Cercek  17 , Emma J Crosbie  18 , Silvio Danese  2 , Evelien Dekker  19 , Maria Daca-Alvarez  20 , Francesco Deni  21 , Mev Dominguez-Valentin  22 , Cathy Eng  23 , Ajay Goel  24 , Josè G Guillem  25 , Britt B S L Houwen  19 , Charles Kahi  26 , Matthew F Kalady  27 , Fay Kastrinos  28 , Florian Kühn  29 , Luigi Laghi  30 , Andrew Latchford  31 , David Liska  32 , Patrick Lynch  33 , Alberto Malesci  2 , Gianluca Mauri  34 , Elisa Meldolesi  9 , Pål Møller  22 , Kevin J Monahan  35 , Gabriela Möslein  36 , Caitlin C Murphy  37 , Karlijn Nass  19 , Kimmie Ng  38 , Cristina Oliani  39 , Enrico Papaleo  40 , Swati G Patel  41 , Marta Puzzono  2 , Andrea Remo  42 , Luigi Ricciardiello  43 , Carla Ida Ripamonti  44 , Salvatore Siena  7 , Satish K Singh  45 , Zsofia K Stadler  17 , Peter P Stanich  46 , Sapna Syngal  47 , Stefano Turi  21 , Emanuele Damiano Urso  48 , Laura Valle  49 , Valeria Stella Vanni  40 , Eduardo Vilar  50 , Marco Vitellaro  51 , Yi-Qian Nancy You  52 , Matthew B Yurgelun  47 , Raffaella Alessia Zuppardo  2 , Elena M Stoffel  53 ; Associazione Italiana Familiarità Ereditarietà Tumori; Collaborative Group of the Americas on Inherited Gastrointestinal Cancer; European Hereditary Tumour Group, and the International Society for Gastrointestinal Hereditary Tumours
Affiliations
Practice Guideline

Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

Giulia Martina Cavestro et al. Clin Gastroenterol Hepatol. 2023 Mar.

Abstract

Background & aims: Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), composed of 69 experts, was convened to develop the first evidence-based consensus recommendations for eoCRC.

Methods: After reviewing the published literature, a Delphi methodology was used to draft and respond to clinically relevant questions. Each statement underwent 3 rounds of voting and reached a consensus level of agreement of ≥80%.

Results: The DIRECt group produced 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive germline genetic testing, ideally before surgery. On the basis of current evidence, endoscopic, surgical, and oncologic treatment of eoCRC should not differ from later-onset CRC, except for individuals with pathogenic or likely pathogenic germline variants. The evidence on chemotherapy is not sufficient to recommend changes to established therapeutic protocols. Fertility preservation and sexual health are important to address in eoCRC survivors. The DIRECt group highlighted areas with knowledge gaps that should be prioritized in future research efforts, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients.

Conclusions: The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accompanying comments and literature reviews. We highlighted areas where research should be prioritized. These guidelines represent a useful tool for clinicians caring for patients with eoCRC.

Keywords: 50 Years; Clinical; Colorectal Cancer; Recommendation; Young.

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