Interpretation of the 2026 ESMO Guideline Update for Localised Colon Cancer: new recommendations and clinical significance of postoperative structured exercise intervention_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIALIN ·Huannixi ^1,2 , HU Tao ³ , YAO Lin ¹ , LI Li ³ ,  WANG Xiaodong ¹

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WANG Xiaodong, Email: wangxiaodong@wchscu.cn

Keywords：

localised colon cancer; European Society for Medical Oncology Guideline; structured exercise intervention; adjuvant management; disease-free survival; CHALLENGE trial

DOI：

10.7507/1007-9424.202604015

Video：

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In 2026, the European Society for Medical Oncology issued an express update to its Clinical Practice Guideline for Localised Colon Cancer. On the basis of randomised evidence from the CHALLENGE (CCTG CO.21) trial, patients with stage Ⅲ or high-risk stage Ⅱ colon cancer who had undergone curative resection and completed standard adjuvant chemotherapy. This article interprets the new recommendations, eligible population, exercise dose, level of evidence, key findings of the CHALLENGE trial, and practical implications for translation into general surgical practice in China. The guideline emphasises that healthcare professionals should inform eligible patients of the potential survival benefit of structured exercise and, after assessing their physical fitness, comorbidities, personal preferences, adherence barriers and financial burden, use shared decision-making to determine whether to recommend participation in a structured exercise programme. The CHALLENGE trial showed that a 3-year structured exercise programme improved disease-free survival and overall survival; however, its target population mainly comprised patients with good performance status who had completed standard adjuvant chemotherapy, and implementation requires trained personnel, behavioural support and integration into follow-up systems. This update indicates that postoperative management of localised colon cancer is moving beyond recurrence surveillance toward quantifiable and evaluable proactive rehabilitation. In China, localised exercise-prescription pathways should be explored through multidisciplinary collaboration, taking into account surgical recovery, anastomotic or stoma-related issues, baseline physical function and available healthcare resources.

Citation： JIALIN ·Huannixi, HU Tao, YAO Lin, LI Li, WANG Xiaodong. Interpretation of the 2026 ESMO Guideline Update for Localised Colon Cancer: new recommendations and clinical significance of postoperative structured exercise intervention. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(6): 751-759. doi: 10.7507/1007-9424.202604015 Copy

1.	Morgan E, Arnold M, Gini A, et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut, 2023, 72(2): 338-344.
2.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3.	Pentheroudakis G, Argilés G, Arnold D, et al. ESMO Clinical Practice Guideline Express Update on the adoption of physical exercise in patients with localised colon cancer. ESMO Open, 2026, 11(2): 106019. doi: 10.1016/j.esmoop.2025.106019.
4.	Courneya KS, Vardy JL, O’Callaghan CJ, et al. Structured exercise after adjuvant chemotherapy for colon cancer. N Engl J Med, 2025, 393(1): 13-25.
5.	Booth CM, Vardy JL, O’Callaghan CJ, et al. A randomized phase Ⅲ trial of the impact of a structured exercise program on disease-free survival (DFS) in stage 3 or high-risk stage 2 colon cancer: CCTG CO. 21 (CHALLENGE). J Clin Oncol, 2025, 43(17_suppl): LBA3510. doi: 10.1200/JCO.2025.43.17_suppl.LBA3510.
6.	Gosavi R, Bell S, McMurrick P, et al. Exercise as adjuvant therapy in colon cancer: implications from the CHALLENGE trial. ANZ J Surg, 2025, 95(9): 1666-1667.
7.	Meyerhardt JA, Giovannucci EL, Holmes MD, et al. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol, 2006, 24(22): 3527-3534.
8.	Meyerhardt JA, Heseltine D, Niedzwiecki D, et al. Impact of physical activity on cancer recurrence and survival in patients with stage Ⅲ colon cancer: findings from CALGB 89803. J Clin Oncol, 2006, 24(22): 3535-3541.
9.	Brown JC, Ma C, Shi Q, et al. Physical activity in stage Ⅲ colon cancer: CALGB/SWOG 80702 (Alliance). J Clin Oncol, 2023, 41(2): 243-254.
10.	Markozannes G, Becerra-Tomás N, Cariolou M, et al. Post-diagnosis physical activity and sedentary behaviour and colorectal cancer prognosis: a Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer, 2024, 155(3): 426-444.
11.	Tsilidis KK, Markozannes G, Becerra-Tomás N, et al. Post-diagnosis adiposity, physical activity, sedentary behaviour, dietary factors, supplement use and colorectal cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading. Int J Cancer, 2024, 155(3): 471-485.
12.	Amirsasan R, Akbarzadeh M, Akbarzadeh S. Exercise and colorectal cancer: prevention and molecular mechanisms. Cancer Cell Int, 2022, 22(1): 247. doi: 10.1186/s12935-022-02670-3.
13.	McTiernan A, Friedenreich CM, Katzmarzyk PT, et al. Physical activity in cancer prevention and survival: a systematic review. Med Sci Sports Exerc, 2019, 51(6): 1252-1261.
14.	Friedenreich CM, Stone CR, Cheung WY, et al. Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectr, 2019, 4(1): pkz080. doi: 10.1093/jncics/pkz080.
15.	Courneya KS, Vardy JL, O’Callaghan CJ, et al. Effects of a structured exercise program on physical activity and fitness in colon cancer survivors: one year feasibility results from the CHALLENGE trial. Cancer Epidemiol Biomarkers Prev, 2016, 25(6): 969-977.
16.	André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med, 2004, 350(23): 2343-2351.
17.	André T, de Gramont A, Vernerey D, et al. Adjuvant fluorouracil, leucovorin, and oxaliplatin in stage Ⅱ to Ⅲ colon cancer: updated 10-year survival and outcomes according to BRAF mutation and mismatch repair status of the MOSAIC study. J Clin Oncol, 2015, 33(35): 4176-4187.
18.	Grothey A, Sobrero AF, Shields AF, et al. Duration of adjuvant chemotherapy for stage Ⅲ colon cancer. N Engl J Med, 2018, 378(13): 1177-1188.
19.	Argilés G, Tabernero J, Labianca R, et al. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2020, 31(10): 1291-1305.
20.	Diao X, Guo C, Jin Y, et al. Cancer situation in China: an analysis based on the global epidemiological data released in 2024. Cancer Commun (Lond), 2025, 45(2): 178-197.
21.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
22.	Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc, 2019, 51(11): 2375-2390.
23.	Schmitz KH, Campbell AM, Stuiver MM, et al. Exercise is medicine in oncology: engaging clinicians to help patients move through cancer. CA Cancer J Clin, 2019, 69(6): 468-484.
24.	Ligibel JA, Bohlke K, May AM, et al. Exercise, diet, and weight management during cancer treatment: ASCO guideline. J Clin Oncol, 2022, 40(22): 2491-2507.
25.	Rock CL, Thomson CA, Sullivan KR, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin, 2022, 72(3): 230-262.
26.	國家衛生健康委員會醫政司, 中華醫學會腫瘤學分會. 中國結直腸癌診療規范 (2023版). 協和醫學雜志, 2023, 14(4): 706-733.
27.	中國抗癌協會腫瘤營養專業委員會, 國家市場監管重點實驗室 (腫瘤特醫食品), 叢明華. 中國惡性腫瘤患者運動治療專家共識. 中國科學: 生命科學, 2022, 52(4): 587-602.
28.	Batalik L, Chamradova K, Winnige P, et al. Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis. BMC Cancer, 2024, 24(1): 600. doi: 10.1186/s12885-024-12348-w.

1. Morgan E, Arnold M, Gini A, et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut, 2023, 72(2): 338-344.
2. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3. Pentheroudakis G, Argilés G, Arnold D, et al. ESMO Clinical Practice Guideline Express Update on the adoption of physical exercise in patients with localised colon cancer. ESMO Open, 2026, 11(2): 106019. doi: 10.1016/j.esmoop.2025.106019.
4. Courneya KS, Vardy JL, O’Callaghan CJ, et al. Structured exercise after adjuvant chemotherapy for colon cancer. N Engl J Med, 2025, 393(1): 13-25.
5. Booth CM, Vardy JL, O’Callaghan CJ, et al. A randomized phase Ⅲ trial of the impact of a structured exercise program on disease-free survival (DFS) in stage 3 or high-risk stage 2 colon cancer: CCTG CO. 21 (CHALLENGE). J Clin Oncol, 2025, 43(17_suppl): LBA3510. doi: 10.1200/JCO.2025.43.17_suppl.LBA3510.
6. Gosavi R, Bell S, McMurrick P, et al. Exercise as adjuvant therapy in colon cancer: implications from the CHALLENGE trial. ANZ J Surg, 2025, 95(9): 1666-1667.
7. Meyerhardt JA, Giovannucci EL, Holmes MD, et al. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol, 2006, 24(22): 3527-3534.
8. Meyerhardt JA, Heseltine D, Niedzwiecki D, et al. Impact of physical activity on cancer recurrence and survival in patients with stage Ⅲ colon cancer: findings from CALGB 89803. J Clin Oncol, 2006, 24(22): 3535-3541.
9. Brown JC, Ma C, Shi Q, et al. Physical activity in stage Ⅲ colon cancer: CALGB/SWOG 80702 (Alliance). J Clin Oncol, 2023, 41(2): 243-254.
10. Markozannes G, Becerra-Tomás N, Cariolou M, et al. Post-diagnosis physical activity and sedentary behaviour and colorectal cancer prognosis: a Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer, 2024, 155(3): 426-444.
11. Tsilidis KK, Markozannes G, Becerra-Tomás N, et al. Post-diagnosis adiposity, physical activity, sedentary behaviour, dietary factors, supplement use and colorectal cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading. Int J Cancer, 2024, 155(3): 471-485.
12. Amirsasan R, Akbarzadeh M, Akbarzadeh S. Exercise and colorectal cancer: prevention and molecular mechanisms. Cancer Cell Int, 2022, 22(1): 247. doi: 10.1186/s12935-022-02670-3.
13. McTiernan A, Friedenreich CM, Katzmarzyk PT, et al. Physical activity in cancer prevention and survival: a systematic review. Med Sci Sports Exerc, 2019, 51(6): 1252-1261.
14. Friedenreich CM, Stone CR, Cheung WY, et al. Physical activity and mortality in cancer survivors: a systematic review and meta-analysis. JNCI Cancer Spectr, 2019, 4(1): pkz080. doi: 10.1093/jncics/pkz080.
15. Courneya KS, Vardy JL, O’Callaghan CJ, et al. Effects of a structured exercise program on physical activity and fitness in colon cancer survivors: one year feasibility results from the CHALLENGE trial. Cancer Epidemiol Biomarkers Prev, 2016, 25(6): 969-977.
16. André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med, 2004, 350(23): 2343-2351.
17. André T, de Gramont A, Vernerey D, et al. Adjuvant fluorouracil, leucovorin, and oxaliplatin in stage Ⅱ to Ⅲ colon cancer: updated 10-year survival and outcomes according to BRAF mutation and mismatch repair status of the MOSAIC study. J Clin Oncol, 2015, 33(35): 4176-4187.
18. Grothey A, Sobrero AF, Shields AF, et al. Duration of adjuvant chemotherapy for stage Ⅲ colon cancer. N Engl J Med, 2018, 378(13): 1177-1188.
19. Argilés G, Tabernero J, Labianca R, et al. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2020, 31(10): 1291-1305.
20. Diao X, Guo C, Jin Y, et al. Cancer situation in China: an analysis based on the global epidemiological data released in 2024. Cancer Commun (Lond), 2025, 45(2): 178-197.
21. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
22. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc, 2019, 51(11): 2375-2390.
23. Schmitz KH, Campbell AM, Stuiver MM, et al. Exercise is medicine in oncology: engaging clinicians to help patients move through cancer. CA Cancer J Clin, 2019, 69(6): 468-484.
24. Ligibel JA, Bohlke K, May AM, et al. Exercise, diet, and weight management during cancer treatment: ASCO guideline. J Clin Oncol, 2022, 40(22): 2491-2507.
25. Rock CL, Thomson CA, Sullivan KR, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin, 2022, 72(3): 230-262.
26. 國家衛生健康委員會醫政司, 中華醫學會腫瘤學分會. 中國結直腸癌診療規范 (2023版). 協和醫學雜志, 2023, 14(4): 706-733.
27. 中國抗癌協會腫瘤營養專業委員會, 國家市場監管重點實驗室 (腫瘤特醫食品), 叢明華. 中國惡性腫瘤患者運動治療專家共識. 中國科學: 生命科學, 2022, 52(4): 587-602.
28. Batalik L, Chamradova K, Winnige P, et al. Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis. BMC Cancer, 2024, 24(1): 600. doi: 10.1186/s12885-024-12348-w.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Interpretation of the 2026 ESMO Guideline Update for Localised Colon Cancer: new recommendations and clinical significance of postoperative structured exercise intervention

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