Surgery for colonic cancer in HNPCC: total vs segmental colectomy

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Hereditary nonpolyposis colorectal cancer (HNPCC) patients have a high risk of metachronous colon cancer (MCC).
• Total colectomy (TC) is debated as the preferred surgery for primary colon cancer in HNPCC due to MCC risk.
• No prior studies compared survival after TC versus segmental colectomy (SC) in HNPCC.

Purpose of the Study:

• To assess MCC risk in HNPCC patients after SC versus TC.
• To compare long-term survival outcomes between SC and TC in HNPCC patients.

Main Methods:

• Prospective cohort study of 60 HNPCC patients with proven germline mismatch repair gene defects (1995-2009).
• Patients underwent either SC or TC for colon adenocarcinoma with curative intent.
• Annual endoscopic surveillance was offered to all participants.

Main Results:

• After a median follow-up of 6 years, MCC developed in 8 of 21 (38%) SC patients versus none of 39 TC patients (P=0.048).
• The 5-year risk of MCC after SC was 20%.
• Colorectal cancer-specific survival was significantly better in the TC group (P=0.048), though overall survival was similar (P=0.29).

Conclusions:

• HNPCC patients face a substantial risk of developing metachronous colon cancer following SC.
• Total colectomy as the primary surgical approach for colon cancer in HNPCC patients effectively eliminates the risk of MCC.