Surveillance decision

Surveillance decision

We will plan an update of the guideline on colorectal cancer (NICE guideline CG131). An extension to the scope of NICE guideline CG131 will be needed to cover areas covered by the guidance on improving outcomes in colorectal cancer (NICE guideline CSG5) that have not been superseded by other NICE guidance.

We will withdraw NICE guideline CSG5 on publication of the update of the colorectal cancer guideline.

Reason for the decision

New evidence that could affect recommendations was identified. Topic experts, including those who helped to develop the guideline, advised us about whether the guidance should be updated.

Improving outcomes in colorectal cancer

For surveillance of NICE guideline CSG5, we looked only for studies about the effects of volume of colorectal cancer surgeries performed by surgeons or by hospitals and found 52 new studies. We also checked whether recommendations in NICE guideline CSG5 have been superseded by other NICE guidance.

Decision: The question about the volume of colorectal cancer surgeries should be included in an update of NICE guideline CG131. Much of CSG5 has been superseded by other NICE guidance. The remaining areas of NICE guideline CSG5 not covered in other NICE guidance should also be covered by the update of NICE guideline CG131. NICE guideline CSG5 should be withdrawn when the updated guidance is published.

Colorectal cancer

We found 329 new studies through surveillance of this guideline. The new evidence was thought to have a potential impact on the following sections of the guideline:

Investigation, diagnosis and staging

  • What is the most effective diagnostic intervention for patients with suspected colorectal cancer to establish a diagnosis?

  • For patients diagnosed with primary colorectal cancer, what is the most effective technique in order to accurately stage the disease (excluding pathology)?

Management of local disease

  • For patients who have undergone local excision and diagnosed stage I colorectal cancer, including/or polyp cancer and with/without neoadjuvant treatment for low rectal tumours, can the use of prognostic factors determine the most effective curative treatment?

  • In patients with clinical or pathological stage II and III rectal cancer what is the effectiveness of adjuvant chemotherapy following surgery?

Management of metastatic disease

  • In patients with colorectal cancer presenting with overt synchronous metastatic disease, what is the effectiveness of treating metastatic disease before, after or at the same time as treating the primary tumour?

  • In a patient with colorectal cancer metastasised to the liver which imaging modality most accurately determines the number and extent of metastases preoperatively?

  • In a patient with colorectal cancer and extrahepatic metastases (for example, lung, brain, peritoneum), which imaging modality most accurately determines the extent of metastases?

  • Capecitabine and tegafur with uracil.

Ongoing care and support

  • In asymptomatic patients who have undergone treatment with curative intent for colorectal cancer, what is the optimal method, frequency and duration of follow‑up?

Areas not currently covered by NICE guideline CG131

  • What is the role of aspirin in primary and secondary prevention of colorectal cancer, including hereditary colorectal cancer?

  • What surgical procedures, techniques, and perioperative interventions improve operative outcomes after surgery for colorectal cancer?

Other clinical areas

For any new evidence relating to published or ongoing NICE technology appraisals, the guideline surveillance review deferred to the technology appraisal decision.

Overall decision

After considering all the new evidence and views of topic experts, we decided that a full update of NICE guideline CG131 is necessary. For NICE guideline CSG5, the evidence relating to surgeon and hospital volumes of colorectal cancer surgeries was also thought to need an update. Checks showed that much of NICE guideline CSG5 has been superseded by other NICE guidance (mainly NICE guideline CG131). We decided that any areas of NICE guideline CSG5 that have not been covered in other guidance should be covered by the update of NICE guideline CG131, resulting in one new guideline.

See how we made the decision for further information.


This page was last updated: 04 February 2016