Clinical question:Management recurrent, resectable CRC

1 Background ................................................................................................................................................................ 1 1.1 The role of surgical treatment .......................................................................................................................... 2 1.2 The role of radiation treatment ........................................................................................................................ 2 2 Systematic review evidence ...................................................................................................................................... 4 2.1 Perioperative mortality, morbidity and adverse events .................................................................................... 5 2.2 Survival outcomes ............................................................................................................................................ 6 2.2.1 Overall survival ....................................................................................................................................... 6 2.2.2 Median survival ....................................................................................................................................... 6 2.2.3 Locoregional relapse-free survival .......................................................................................................... 6 2.3 Quality-of-life outcomes ................................................................................................................................... 6 3 Evidence summary and recommendations ................................................................................................................ 7 3.1 Considerations in making these recommendations .......................................................................................... 8 3.1.1 Limitations of the body of evidence ........................................................................................................ 9 3.1.2 Additional evidence from case series in rectal cancer ............................................................................ 9 3.1.3 Post-operative complications and quality of life ...................................................................................... 9 3.1.4 Cost effectiveness ................................................................................................................................. 10 3.1.5 Application of the evidence to colon cancer .......................................................................................... 10 3.2 Health system implications ............................................................................................................................. 10 3.2.1 Clinical practice ..................................................................................................................................... 10 3.2.2 Resourcing ............................................................................................................................................ 10 3.2.3 Barriers to implementation ................................................................................................................... 10 4 Discussion ................................................................................................................................................................ 11 4.1 Unresolved issues ........................................................................................................................................... 11 4.2 Studies currently underway ............................................................................................................................ 11 4.3 Future research priorities ............................................................................................................................... 11 5 References ............................................................................................................................................................... 11 6 Appendices .............................................................................................................................................................. 14