[Modification of surgical strategy in HNPCC by molecular and clinical aspects]

Because of the positive correlation between Amsterdam criteria and positive MSI analysis, a subtotal colectomy with ileorectal anastomosis seems to be indicated in patients with positive Amsterdam criteria to eliminate the high risk of metachronous colon cancer. In patients with an identified mutation in one of the known mismatch repair genes, a subtotal colectomy is indicated as well. In patients with positive Bethesda criteria, apart from the Amsterdam criteria, a subtotal colectomy seems only to be indicated if a positive MSI analysis is available.