Hereditary nonpolyposis colorectal cancer surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
Surgery is the mainstay of treatment for hereditary nonpolyposis colorectal cancer.[1] Surgical resection is recommended among patients with HPNCC because of the high rate of metachronous colorectal cancer. Subtotal colectomy with ileorectal anastomosis and postsurgical endoscopic rectal surveillance are advised when colorectal cancer develops in the setting of HNPCC.
Surgery
- Surgical resection is recommended among patients with HPNCC because of the high rate of metachronous colorectal cancer.
- Subtotal colectomy with ileorectal anastomosis and postsurgical endoscopic rectal surveillance are advised when colorectal cancer develops in the setting of HNPCC.
- The following types of surgical treatment are recommended:
- Proctocolectomy with ileostomy.
- Colectomy with ileo-rectal anastomosis and/or proctocolectomy with ileo-anal "pouch".[2]
- Proctocolectomy with ileostomy is the most radical but later the risk of recurrence is very low. However, such treatment is highly traumatising and frequently leads to urinary tract abnormalities and sexual dysfunction.
- Colectomy with ileorectal anastomosis does not lead to such complications but should be followed by frequent examinations due to the risk of cancer in the unresected fragment of bowel.
- Other method is the proctocoloctomy with ileo-anal "pouch" S, J, W or H.[2]
- Female HNPCC patients undergoing surgery due to colorectal cancer and at perimenopausal age or older should also consider extending their surgery to receive a hysterectomy and adnexectomy due to increased risk of primary endometrial and ovarian cancers.
- All the procedures are characterized by increasing frequency of complications. However, they are recommended in the treatment of HNPCC because the underlying problem for patients is the high risk of second primary colorectal cancer.
- Endoscopic polypectomy is recommended in the case of polyps which are benign and non-recurrent. However, in patients with adenomas that are multiple and/or recurrent and/or of a significant degree of dysplasia and/or villous, prophylactic colectomy should be considered.
- The high proportion of synchronous tumors (more than 15% of patients at the time of diagnosis) or metachronous tumors (about 45% during 10 years following surgery of the primary tumor) suggests that for preventive surgery as for surgery in patients from HNPCC families with histopathologically diagnosed.[2]
Prophylactic Surgery
The feasibility of prophylactic surgery of the colon, uterus and ovaries depends on a individual basis for HNPCC patients.[3] However, in some cases screen-detected family members and symptomatic individuals (young adults) are eligible for prophylactic colorectal surgery. Most experts believe that prophylactic surgery should not be recommended to patients without any pathological changes of the colon even if such persons are carriers of a mutation.[4]
Gallery
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![Right image: Total colectomy for multiple metachronous colon cancer[Creative Commons BY-SA-NC][5]](/images/0/09/Lynchsyndrome_grosspathology.jpg)
Right image: Total colectomy for multiple metachronous colon cancer[Creative Commons BY-SA-NC][5]
![Right image: Total colectomy for multiple metachronous colon cancer[Creative Commons BY-SA-NC][5]](/index.php/File:Lynchsyndrome_grosspathology.jpg){kind=small}
References
- ↑ Treatment of hereditary nonpolyposis colorectal cancer.Wikipedia.https://en.wikipedia.org/wiki/Hereditary_nonpolyposis_colorectal_cancer#Treatment Accessed on December 2, 2015
- ↑ 2.0 2.1 2.2 Kladny J, Lubinski J. Lynch syndrome (HNPCC). Hered Cancer Clin Pract. 2008;6(2):99-102.
- ↑ Gryfe R (2009). "Inherited colorectal cancer syndromes". Clin Colon Rectal Surg. 22 (4): 198–208. doi:10.1055/s-0029-1242459. PMC 2796102. PMID 21037810.
- ↑ Schmeler KM, Lynch HT, Chen LM, Munsell MF, Soliman PT, Clark MB, Daniels MS, White KG, Boyd-Rogers SG, Conrad PG, Yang KY, Rubin MM, Sun CC, Slomovitz BM, Gershenson DM, Lu KH (2006). "Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome". N. Engl. J. Med. 354 (3): 261–9. doi:10.1056/NEJMoa052627. PMID 16421367.
- ↑ Kochi M, Shimomura M, Hinoi T, et al. Total colectomy for multiple metachronous colon cancers in a patient with Lynch syndrome. Surg Case Rep. 2015;1(1):78.