{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T01:41:56Z","timestamp":1780537316027,"version":"3.54.1"},"reference-count":29,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 \u00ae), 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.<\/jats:p>","DOI":"10.3390\/cancers14215255","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T09:59:37Z","timestamp":1666778377000},"page":"5255","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Colorectal Cancer and the Obese Patient: A Call for Guidelines"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6295-2451","authenticated-orcid":false,"given":"Nikoletta A.","family":"Petrou","sequence":"first","affiliation":[{"name":"Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henna","family":"Rafique","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK"},{"name":"Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahnawaz","family":"Rasheed","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paris","family":"Tekkis","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK"},{"name":"Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK"},{"name":"Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1828-1395","authenticated-orcid":false,"given":"Christos","family":"Kontovounisios","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK"},{"name":"Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK"},{"name":"Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"ref_1","unstructured":"(2022, August 01). Obesity and Overweight. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_2","unstructured":"(2022, August 08). A Healthy Lifestyle\u2014WHO Recommendations. Available online: https:\/\/www.who.int\/europe\/news-room\/fact-sheets\/item\/a-healthy-lifestyle---who-recommendations."},{"key":"ref_3","unstructured":"(2022, August 01). Bowel Cancer Risk. Available online: https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/bowel-cancer\/incidence#heading-Zero."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1136\/gutjnl-2013-304701","article-title":"Obesity and colorectal cancer","volume":"62","author":"Bardou","year":"2013","journal-title":"Gut"},{"key":"ref_5","unstructured":"(2022, August 01). Bowel Cancer Statistics. Available online: https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/bowel-cancer."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1038\/bjc.2016.304","article-title":"Cancer incidence and mortality projections in the UK until 2035","volume":"115","author":"Smittenaar","year":"2016","journal-title":"Br. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.metabol.2018.11.001","article-title":"Obesity and cancer risk: Emerging biological mechanisms and perspectives","volume":"92","author":"Avgerinos","year":"2019","journal-title":"Metabolism"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ma, Y., Yang, Y., Wang, F., Zhang, P., Shi, C., Zou, Y., and Qin, H. (2013). Obesity and risk of colorectal cancer: A systematic review of prospective studies. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0053916"},{"key":"ref_9","unstructured":"(2022, August 01). Bowel Cancer Risk. Available online: https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/bowel-cancer\/risk-factors#heading-Five."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1002\/bjs.7160","article-title":"Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer","volume":"97","author":"Jayne","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_11","first-page":"17","article-title":"Minimally Invasive Surgery for Colorectal Cancer","volume":"4","author":"Yamauchi","year":"2021","journal-title":"JMA J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1111\/ans.15081","article-title":"Oncological safety of laparoscopic versus open colorectal cancer surgery in obesity: A systematic review and meta-analysis","volume":"89","author":"Bell","year":"2019","journal-title":"ANZ J. Surg."},{"key":"ref_13","unstructured":"(2022, August 01). Referenced with Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae) for Guidelines for Colon Cancer Version 1, 2022. \u00a9 National Comprehensive Cancer Network, Inc. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way."},{"key":"ref_14","unstructured":"(2022, August 01). Referenced with Permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae) for Guidelines for Rectal Cancer Version 1, 2022. \u00a9 National Comprehensive Cancer Network, Inc. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.annonc.2020.06.022","article-title":"Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Tabernero","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_16","first-page":"iv22","article-title":"Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Wyrwicz","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1093\/annonc\/mdw235","article-title":"ESMO consensus guidelines for the management of patients with metastatic colorectal cancer","volume":"27","author":"Cervantes","year":"2016","journal-title":"Ann. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10147-019-01485-z","article-title":"Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer","volume":"25","author":"Hashiguchi","year":"2020","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"AB89","DOI":"10.1016\/j.gie.2008.03.072","article-title":"Colonoscopy in Obese Patients: A Growing Problem","volume":"67","author":"Desormeaux","year":"2008","journal-title":"Gastrointest. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"20170931","DOI":"10.1259\/bjr.20170931","article-title":"Technical challenges of imaging & image-guided interventions in obese patients","volume":"91","author":"Uppot","year":"2018","journal-title":"Br. J. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jmig.2013.09.009","article-title":"Laparoscopy in the morbidly obese: Physiologic considerations and surgical techniques to optimize success","volume":"21","author":"Scheib","year":"2014","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s10151-019-02027-5","article-title":"Minimally invasive colorectal cancer procedures in patients with obesity: An interdisciplinary approach","volume":"23","author":"Alyaqout","year":"2019","journal-title":"Tech. Coloproctol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1177\/000313481608200418","article-title":"Obesity and the Risk for Surgical Site Infection in Abdominal Surgery","volume":"82","author":"Winfield","year":"2016","journal-title":"Am. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Wang, J., Johnson, N.W., Casey, L., Carne, P.W.G., Bell, S., Chin, M., Simpson, P., and Kong, J.C. (2022). Robotic colon surgery in obese patients: A systematic review and meta-analysis. ANZ J. Surg., epub ahead of print.","DOI":"10.1111\/ans.17749"},{"key":"ref_25","first-page":"312","article-title":"Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy","volume":"13","author":"Hellan","year":"2009","journal-title":"JSLS"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.bjae.2020.07.003","article-title":"Anaesthesia for the obese patient","volume":"20","author":"Bouch","year":"2020","journal-title":"BJA Educ."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1200\/JCO.21.00471","article-title":"Appropriate Systemic Therapy Dosing for Obese Adult Patients With Cancer: ASCO Guideline Update","volume":"39","author":"Griggs","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/COC.0000000000000150","article-title":"Oncologic and Functional Hazards of Obesity Among Patients With Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiation Therapy","volume":"40","author":"Park","year":"2017","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3899","DOI":"10.1245\/s10434-013-3087-2","article-title":"Obesity and peritoneal surface disease: Outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for appendiceal and colon primary tumors","volume":"20","author":"Votanopoulos","year":"2013","journal-title":"Ann. Surg. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/21\/5255\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:03:28Z","timestamp":1760144608000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/21\/5255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,26]]},"references-count":29,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["cancers14215255"],"URL":"https:\/\/doi.org\/10.3390\/cancers14215255","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,26]]}}}