BACKGROUND: Data registries lack a definitive classification system that distinguishes different locations of colon cancer from one another. OBJECTIVE: To establish an international consensus on the definition of primary colon cancer segment locations. DESIGN: Between December 2022 and June 2023, the Delphi survey study was conducted to seek opinions from relevant international experts and eventually develop a consensus definition of each colon cancer segment. SETTING: Three-round online-based Delphi survey study. INTERVENTIONS: The online survey included 17 questions. In the first 2 rounds, participating experts were asked to rank each statement on a scale of 1 (least relevant) to 9 (most relevant). Consensus statements and definitions were revised according to the results for statements obtaining a consensus score of 7 to 9. During the third round and online meeting, definitions and statements that reached a moderate or high consensus (above 4 for more than 70% of participants) were included. MAIN OUTCOME MEASURES: The primary goal of our project was focused on precisely localizing the specific segment affected by primary colon cancer rather than identifying surgical treatment or type of resection needed for a particular segment. RESULTS: The first round included 331 experts; 301 (91%) completed the second round and 295 (98%) completed the final round. Experts strongly supported the use of a "10-cm rule" to describe colon cancer sites at the flexures and anatomical landmarks for other segments. Regarding the definition of rectosigmoid cancer, experts from United States and Europe reached a high consensus that the term rectosigmoid as a colon cancer location must be abolished in contrast to experts from Asia. The description of overlapping segments of cancers achieved a consensus of 64%. LIMITATIONS: Subjective decisions are based on individual expert clinical experience. CONCLUSIONS: This Delphi survey, the first internationally conducted consensus study, achieved a remarkable level of consensus among a panel of global experts. Ambiguity still exists regarding overlapping lesions. See Video Abstract . ESTANDARIZACIN DE LA DEFINICIN DE CADA SEGMENTO DE CNCER DE COLON CONSENSO DELPHI SOBRE LA TOMA DE DECISIONES CLNICAS PARA RESULTADOS ONCOLGICOS: ANTECEDENTES:Las bases de datos carecen de un sistema de clasificación definitivo que distinga las diferentes localizaciones del cáncer de colon.OBJETIVO:Establecer un consenso internacional sobre la definición de las localizaciones de los segmentos del cáncer de colon priamrio.DISEÑO:Entre diciembre de 2022 y junio de 2023, se realizó un estudio Delphi para recabar la opinión de expertos internacionales relevantes y, finalmente, desarrollar una definición consensuada de cada segmento del cáncer de colon.ESCENARIO:Estudio Delphi en línea de 3 rondas.INTERVENCIONES:La encuesta en línea incluyó 17 preguntas. En las dos primeras rondas, se pidió a los expertos participantes que calificaran cada afirmación en una escala del 1 al 9 (9 es la más relevante). Las afirmaciones y definiciones de consenso se revisaron según los resultados, obteniendo una puntuación de consenso de 7 a 9. Durante la tercera ronda y la reunión en línea, se incluyeron las definiciones y afirmaciones que alcanzaron un consenso moderado o alto (superior a 4 en más del 70 % de los participantes).MEDIDA PRINCIPALES DE RESULTADOS:El objetivo principal de nuestro proyecto se centró en localizar con precisión el segmento específico afectado por el cáncer de colon primario, en lugar de identificar el tratamiento quirúrgico o el tipo de resección necesario para un segmento en particular.RESULTADOS:La primera ronda incluyó a 331 expertos, 301 (91%) completaron la segunda ronda y 295 (98%) completaron la ronda final. Los expertos apoyaron firmemente el uso de una "regla de 10 cm" para describir las localizaciones del cáncer de colon en las flexuras y puntos de referencia anatómicos para otros segmentos. En cuanto a la definición de cáncer rectosigmoideo, expertos de América y Europa alcanzaron un alto consenso en la necesidad de abolir el término "rectosigmoide" como localización del cáncer de colon, a diferencia de los expertos de Asia. La descripción de los cánceres en segmentos que se superponen a alcanzó un consenso del 64%.LIMITACIONES:Las decisiones subjetivas se basan en la experiencia clínica individual de cada experto.CONCLUSIONES:Esta encuesta Delphi, el primer estudio de consenso realizado a nivel internacional, alcanzó un notable nivel de consenso entre un panel de expertos globales. Todavía existe ambigüedad en cuanto a las lesiones superpuestas. (Traducción-Dr. Jorge Silva Velazco ).

1st Moscow State Medical University Sechenov University Moscow Russia

Cankiri State Hospital Cankiri Turkey

Champalimaud Cancer Foundation Lisbon Portugal

Consultant Colorectal Surgeon St Mark's Hospital London United Kingdom

Department of Biomedical Sciences Humanitas University and IRCCS Humanitas Research Hospital Division of Colon and Rectal Surgery Milan Italy

Department of Biostatistics Faculty of Medicine Ankara University Ankara Turkey

Department of Colorectal Surgery Digestive Disease and Surgery Institute Cleveland Clinic Cleveland Ohio

Department of Colorectal Surgery National Cancer Center National Clinical Research Center for Cancer Cancer Hospital Chinese Academy of Medical Science and Peking Union Medical College Beijing People's Republic of China

Department of General Surgery School of Medicine Ankara University Ankara Turkey

Department of Surgery Copenhagen University Hospital North Zealand Hillerød Denmark; Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Department of Surgery Section of Colorectal Surgery Massachusetts General Hospital Cancer Center Harvard Medical School Boston Massachusetts

Department of Surgery University Medical Center Groningen Groningen the Netherlands

Dept of Pelvic Cancer Div Coloproctology Karolinska University Hospital Stockholm Sweden

Director Center for Hereditary Tumors BETHESDA Khs Duisburg Germany

Division of Colon and Rectal Surgery Department of Surgery University of Minnesota Minneapolis Minnesota

Division of Colon and Rectal Surgery Mayo Clinic Rochester Minnesota

Division of Colorectal Surgery Cleveland Clinic Jacksonville Florida

Head Colorectal Division Department of General and Minimal Access Surgery Sher i Kashmir Institute of Medical Sciences Srinagar Jammu and Kashmir India

Head of colorectal surgery unit General Surgery Department Institució del Campus Barcelona Hospital Campus Barcelona Spain

Head of the Coloproctology Service British Hospital of Buenos Aires Buenos Aires Argentina

Hospital Alemão Oswaldo Cruz São Paulo Brasil

Montpellier Cancer Institute Department of Surgery Montpellier France

Pathology and Data Analytics University of Leeds Leeds United Kingdom

Professor of Gastrointestinal Cancer Imaging Imperial College London London United Kingdom

Samsung Medical Center Seoul South Korea

Sydney Adventist Hospital Wahroonga Australia

Tokyo Medical and Dental University Tokyo Japan

Universitatsklinikum Erlangen Erlangen Germany

University Hospital Lausanne Lausanne Switzerland

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