Colorectal Cancer and the Obese Patient: A Call for Guidelines

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.