Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Society of Colon and Rectal Surgeons.

Management of Rectal Cancer

American Society of Colon and Rectal Surgeons

Publication Date: Dec 31, 2012

Page Last Updated: May 5, 2026

The GRADE system: grading recommendations

Grade	Description	Benefit vs. risk and burdens	Quality of supporting evidence	Implications
1A	Strong recommendation, High-quality evidence	Benefits clearly outweigh risk and burdens or vice versa	RCTs without important limitations or overwhelming evidence from observational studies	Strong recommendation, can apply to most patients in most circumstances without reservation
1B	Strong recommendation, Moderate-quality evidence	Benefits clearly outweigh risk and burdens or vice versa	RCTs with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or exceptionally strong evidence from observational studies	Strong recommendation, can apply to most patients in most circumstances without reservation
1C	Strong recommendation, Low- or very-low quality evidence	Benefits clearly outweigh risk and burdens or vice versa	Observational studies or case series	Strong recommendation but may change when higherquality evidence becomes available
2A	Weak recommendation, High-quality evidence	Benefits closely balanced with risks and burdens	RCTs without important limitations or overwhelming evidence from observational studies	Weak recommendation, best action may differ depending on circumstances or patients’ or societal values
2B	Weak recommendations, Moderate-quality evidence	Benefits closely balanced with risks and burdens	RCTs with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or exceptionally strong evidence from observational studies	Weak recommendation, best action may differ depending on circumstances or patients’ or societal values
2C	Weak recommendation, Low- or very-low quality evidence	Uncertainty in the estimates of benefits, risks and burden; benefits, risk, and burden may be closely balanced	Observational studies or case series	Very weak recommendations; other alternatives may be equally reasonable

Document Overview

Document Title: Management of Rectal Cancer

Authoring Society: American Society of Colon and Rectal Surgeons

Document Publication Date: Dec 31, 2012

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.doi.org/10.1097/DCR.0000000000001762

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Scope: Management, Prevention

Diseases/Conditions (MeSH)

D012004 - Rectal Neoplasms

D012003 - Rectal Fistula

D012004 - Rectal Neoplasms

Keywords: chemotherapy, colorectal cancer, total mesorectal excision

Inclusion Criteria: Female, Male, Adolescent, Adult, Child, Infant, Older Adult

Health Care Settings: Ambulatory, Emergency Care, Hospital, Outpatient, Radiology Services

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant, Radiology Technologist, Surgical Technologist

Recommendation Development Processes & Methodology

Number of Source Documents: 362

Literature Search Start Date: Monday, December 31, 2012

Literature Search End Date: Tuesday, January 14, 2020

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: No

Discloses conflicts of interest?: No

Includes benefits/harms analysis with recommendations?: Yes

Management of Rectal Cancer

Recommendations

PREOPERATIVE ASSESSMENT

Evaluation

Staging

Multidisciplinary Treatment Planning

TREATMENT

Surgical Techniques and Operative Considerations

Local Excision

Radical Resection

Tumor-Related Emergencies

Multimodality Therapy for Nonmetastatic Rectal Cancer

Neoadjuvant Therapy

Adjuvant Therapy

Multimodality Therapy for Rectal Cancer With Synchronous Metastatic Disease

DOCUMENTATION

The GRADE system: grading recommendations

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology