Colorectal Cancer and the Obese Patient: A Call for Guidelines

SIMPLE SUMMARY: Obese patients are known to be at higher risk of developing colorectal cancer. Meanwhile, the rate of obesity continues to rise worldwide. Current guidelines by the National Comprehensive Cancer Network(®) (NCCN(®)), the European Society of Medical Oncology (ESMO), and the Japanese Society for Cancer of the Colon and Rectum (JSCCR) are not modified to account for the needs of obese patients with colorectal cancer. In this study we aimed to review and compare the existing guidelines and make recommendations specific to this group of patients. We proposed changes in the diagnostic work-up, follow-up and surveillance, perioperative pathways, and management of metastatic disease, with an emphasis on minimally invasive surgical procedures. We concluded that there is need to modify the existing colorectal cancer guidelines to address the needs of obese patients and recommend that a multidisciplinary approach, with involvement of bariatric principles, should be considered. ABSTRACT: The link between obesity and colorectal cancer has been well established. The worldwide rise in obesity rates in the past 40 years means that we are dealing with increasing numbers of obese patients with colorectal cancer. We aimed to review the existing guidelines and make recommendations specific to this group of patients. Upon comparing the current NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®), the guidelines from the European Society of Medical Oncology (ESMO) and the guidelines of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), we observed that these did not take into consideration the needs of obese patients. We proceeded to make specific recommendations with regards to the diagnostic work-up, surgical pathways, minimally invasive technique, perioperative treatment, post-operative surveillance, and management of metastatic disease in this group of patients. Our review highlights the need for modification of the existing guidelines to account for the needs of this patient cohort. A multidisciplinary approach, including principles used by bariatric surgeons, should be the way forward to reach consensus in the management of this group of patients.