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abstract
Abstract
Objective: To define the neoplastic risk in the remaining
colon after proctectomy for rectal cancer in patients with hereditary
nonpolyposis colorectal cancer (HNPCC). (Lynch Syndrome)
Conclusions: Surgeons and patients need to be aware of substantial risk for metachronous neoplasia after proctectomy. Selection of operation should be individualized, but total proctocolectomy and ileoanal pouch should be strongly considered. If patients undergo proctectomy alone, close surveillance is mandatory.
Conclusions: Surgeons and patients need to be aware of substantial risk for metachronous neoplasia after proctectomy. Selection of operation should be individualized, but total proctocolectomy and ileoanal pouch should be strongly considered. If patients undergo proctectomy alone, close surveillance is mandatory.
Background: The extent of surgery for rectal cancer in
HNPCC is controversial. In determining which operation to perform,
surgeons and patients must consider cancer risk in the remaining colon
as well as functional consequences of removing the entire colorectum.
The natural history of colon neoplasia in this situation is understudied
and is not well-defined.
Methods: A single-institution hereditary colorectal
cancer database was queried for patients meeting Amsterdam criteria and
with rectal cancer. Patient demographics, surgical management, and
follow-up were recorded.
Results: Fifty HNPCC patients with a primary diagnosis of
rectal cancer treated by proctectcomy were included. Detailed follow-up
colonoscopy data were available for 33 patients. Forty-eight high-risk
adenomas developed in 13 patients (39.4%). Five patients (15.2%)
developed metachronous adenocarcinoma at a median of 6 years (range
3.5-16) after proctectomy, including 3 at advanced stage. One of these
patients developed a high-risk adenoma before cancer. Mean interval
between the last normal colonoscopy and cancer discovery was 42 months
(range 23.8-62.1) with one developing within 2 years. Thus, 17 of 33
patients (51.5%) developed high-risk adenoma or cancer after
proctectomy.
Conclusions: Surgeons and patients need to be aware of
substantial risk for metachronous neoplasia after proctectomy. Selection
of operation should be individualized, but total proctocolectomy and
ileoanal pouch should be strongly considered. If patients undergo
proctectomy alone, close surveillance is mandatory.
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