(Stedman's) metachronous - Not synchronous; multiple separate occurrences, such as multiple primary cancers developing at intervals.
abstract (Korea)
BACKGROUND:
The
survival benefit of extensive colectomy is controversial in Lynch
syndrome, and risk factors for metachronous colorectal cancer (CRC)
after segmental colectomy are unclear.
OBJECTIVE:
The
aim of this study was to investigate the survival outcome and risk of
metachronous CRC after surgery in Lynch syndrome patients diagnosed with
their first CRC.
METHODS:
Overall,
106 patients with Lynch syndrome who underwent surgery for CRC were
included in the study. The demographics, genotype, clinicopathological
characteristics of the index CRC, and follow-up data were reviewed from a
single-institution Lynch syndrome database.
RESULTS:
Of
30 patients who underwent extensive surgery, no metachronous CRC was
developed during a mean follow-up of 68.1 months. Of 76 patients who
underwent segmental colectomy, 13 (17.1 %) developed metachronous CRC
during a mean follow-up of 77.2 months. The cumulative risk of
metachronous CRC was 8.4 % at 5 years and 20.4 % at 10 years after
segmental colectomy. No difference in overall and CRC-specific survival
was observed between segmental colectomy and extensive colectomy
(p = 0.277 and p = 0.659, respectively). A 25 cm or longer resection of
bowel decreased the risk of metachronous CRC after segmental colectomy
compared with less extensive resection (hazard ratio 0.10, 95 %
confidence interval 0.01-0.86). Annual surveillance colonoscopy did not
decrease the risk of metachronous CRC compared with less frequent
surveillance colonoscopy. Although not statistically significant, none
of the MSH6 gene mutation carriers were diagnosed with metachronous CRC.
CONCLUSIONS:
Although
no survival benefit was identified, surgeons and patients might
consider extensive colectomy to prevent metachronous CRC in Lynch
syndrome patients regardless of their clinicopathological
characteristics.
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