[Impact of the French consensus guidelines on the management of colonic and rectal cancer: a population-based study]

To compare the management of colorectal cancer (CRC) before and after the French consensus conferences of rectal cancer (RC) in 1994 and colonic cancer (CC) in 1998.

From 344 CCR incident cases in 1992 and 545 in 2000, patient characteristics, tumor data, and diagnostic and treatment modalities were collected to compare the management of CRC.

Post-operative mortality did not change significantly (4% in 1992 and 2.8% in 2000). No trends were observed in disease stage at diagnosis or rate of resection. For patients with CC (n=244 in 1992 and n=396 in 2000), the number of resection specimens with at least 12 lymph nodes increased from 11% in 1992 to 27% in 2000 (p<0.001). For CC with Dukes stage C and D, the use of chemotherapy increased significantly: for Dukes Stage C from 45% in 1992 to 55% in 2000; for Dukes Stage D from 37% in 1992 to 67% in 2000. For patients with RC (n=100 in 1992 and n=149 in 2000), no change in use of adjuvant radiotherapy was observed: 59% in 1992 versus 53.4% in 2000. Preoperative radiotherapy for RC was performed in 63% in 1992 and 75% in 2000 (p=0.7).

The consensus guidelines appear to have moderately influenced management practices. A better diffusion of guidelines to practitioners and a systematic evaluation of actual practices would be helpful to improve their impact.