Introduction: preparation for surgery and perioperative optimisation

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Clinical practice guidelines for the prevention, early detection and management of colorectal cancer > Introduction: preparation for surgery and perioperative optimisation


Most patients diagnosed with colorectal carcinoma will undergo an operation. This may occur soon after diagnosis or may occur after neoadjuvant therapy in the case of rectal carcinoma, or after chemotherapy in patients with metastatic disease.

The decision to operate on an individual patient is based on an assessment of the patient’s cancer burden, but also on patient factors including pre-existing comorbidities and patient’s wishes.

Adequate pre-operative assessment will vary between patients, but in addition to pre-operative cancer staging, it should incorporate blood tests (including anaemia screening, electrolytes and CEACarcinoembryonic antigen. A protein that may be found in the blood of a person with colorectal cancer. levels)[1][2][3][4] cardiopulmonary testing in selected patients, and referral to specialist services including a perioperative physician if necessary.[5][6]

Patients having elective colorectal cancer surgery should ideally be seen in a pre-admission clinic if available, and/or by an anaesthetist if possible.

A variety of measures and interventions can be used in the perioperative period to improve patient outcomes in the short and long term.


  1. Harrison LE, Guillem JG, Paty P, Cohen AM. Preoperative carcinoembryonic antigen predicts outcomes in node-negative colon cancer patients: a multivariate analysis of 572 patients. J Am Coll Surg 1997 Jul;185(1):55-9 Abstract available at
  2. Yang KM, Park IJ, Kim CW, Roh SA, Cho DH, Kim JC. The prognostic significance and treatment modality for elevated pre- and postoperative serum CEA in colorectal cancer patients. Ann Surg Treat Res 2016 Oct;91(4):165-171 Abstract available at
  3. Kotzé A, Harris A, Baker C, Iqbal T, Lavies N, Richards T, et al. British Committee for Standards in Haematology Guidelines on the Identification and Management of Pre-Operative Anaemia. Br J Haematol 2015 Nov;171(3):322-31 Abstract available at
  4. Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 2006 Jan 25;(1):CD005033 Abstract available at
  5. Cheema FN, Abraham NS, Berger DH, Albo D, Taffet GE, Naik AD. Novel approaches to perioperative assessment and intervention may improve long-term outcomes after colorectal cancer resection in older adults. Ann Surg 2011 May;253(5):867-74 Abstract available at
  6. O'Neill F, Carter E, Pink N, Smith I. Routine preoperative tests for elective surgery: summary of updated NICE guidance. BMJ 2016 Jul 14;354:i3292 Abstract available at

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