Annals of Surgical Oncology

, Volume 20, Issue 6, pp 1829–1836 | Cite as

Risk of Metachronous Colon Cancer Following Surgery for Rectal Cancer in Mismatch Repair Gene Mutation Carriers

  • Aung Ko Win
  • Susan Parry
  • Bryan Parry
  • Matthew F. Kalady
  • Finlay A. Macrae
  • Dennis J. Ahnen
  • Graeme P. Young
  • Lara Lipton
  • Ingrid Winship
  • Alex Boussioutas
  • Joanne P. Young
  • Daniel D. Buchanan
  • Julie Arnold
  • Loïc Le Marchand
  • Polly A. Newcomb
  • Robert W. Haile
  • Noralane M. Lindor
  • Steven Gallinger
  • John L. Hopper
  • Mark A. Jenkins
Colorectal Cancer

Abstract

Background

Despite regular surveillance colonoscopy, the metachronous colorectal cancer risk for mismatch repair (MMR) gene mutation carriers after segmental resection for colon cancer is high and total or subtotal colectomy is the preferred option. However, if the index cancer is in the rectum, management decisions are complicated by considerations of impaired bowel function. We aimed to estimate the risk of metachronous colon cancer for MMR gene mutation carriers who underwent a proctectomy for index rectal cancer.

Methods

This retrospective cohort study comprised 79 carriers of germline mutation in a MMR gene (18 MLH1, 55 MSH2, 4 MSH6, and 2 PMS2) from the Colon Cancer Family Registry who had had a proctectomy for index rectal cancer. Cumulative risks of metachronous colon cancer were calculated using the Kaplan–Meier method.

Results

During median 9 years (range 1–32 years) of observation since the first diagnosis of rectal cancer, 21 carriers (27 %) were diagnosed with metachronous colon cancer (incidence 24.25, 95 % confidence interval [CI] 15.81–37.19 per 1,000 person-years). Cumulative risk of metachronous colon cancer was 19 % (95 % CI 9–31 %) at 10 years, 47 (95 % CI 31–68 %) at 20 years, and 69 % (95 % CI 45–89 %) at 30 years after surgical resection. The frequency of surveillance colonoscopy was 1 colonoscopy per 1.16 years (95 % CI 1.01–1.31 years). The AJCC stages of the metachronous cancers, where available, were 72 % stage I, 22 % stage II, and 6 % stage III.

Conclusions

Given the high metachronous colon cancer risk for MMR gene mutation carriers diagnosed with an index rectal cancer, proctocolectomy may need to be considered.

Supplementary material

10434_2012_2858_MOESM1_ESM.doc (72 kb)
Supplementary material 1 (DOC 73 kb)

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Aung Ko Win
    • 1
  • Susan Parry
    • 2
    • 3
  • Bryan Parry
    • 4
  • Matthew F. Kalady
    • 5
  • Finlay A. Macrae
    • 6
  • Dennis J. Ahnen
    • 7
  • Graeme P. Young
    • 8
  • Lara Lipton
    • 9
  • Ingrid Winship
    • 10
    • 11
  • Alex Boussioutas
    • 12
    • 13
    • 14
  • Joanne P. Young
    • 15
  • Daniel D. Buchanan
    • 15
  • Julie Arnold
    • 2
  • Loïc Le Marchand
    • 16
  • Polly A. Newcomb
    • 17
  • Robert W. Haile
    • 18
  • Noralane M. Lindor
    • 19
  • Steven Gallinger
    • 20
    • 21
  • John L. Hopper
    • 1
  • Mark A. Jenkins
    • 1
  1. 1.Centre for Molecular, Environmental, Genetic and Analytic EpidemiologyThe University of MelbourneParkvilleAustralia
  2. 2.New Zealand Familial Gastrointestinal Cancer RegistryAuckland City HospitalAucklandNew Zealand
  3. 3.Department of GastroenterologyMiddlemore HospitalAucklandNew Zealand
  4. 4.Colorectal Surgical UnitAuckland City HospitalAucklandNew Zealand
  5. 5.Department of Colorectal Surgery, Digestive Disease InstituteCleveland ClinicClevelandUSA
  6. 6.Colorectal Medicine and GeneticsThe Royal Melbourne HospitalParkvilleAustralia
  7. 7.Denver VA Medical Center, School of MedicineUniversity of ColoradoDenverUSA
  8. 8.Flinders Centre for Innovation in CancerFlinders UniversityAdelaideAustralia
  9. 9.Ludwig Institute for Cancer ResearchThe Royal Melbourne HospitalParkvilleAustralia
  10. 10.Department of MedicineThe University of MelbourneParkvilleAustralia
  11. 11.Genetic MedicineThe Royal Melbourne HospitalParkvilleAustralia
  12. 12.Department of MedicineRoyal Melbourne Hospital, The University of MelbourneParkvilleAustralia
  13. 13.Cancer Genomics and Predictive MedicinePeter MacCallum Cancer CentreEast MelbourneAustralia
  14. 14.Sir Peter MacCallum Department of OncologyThe University of MelbourneParkvilleAustralia
  15. 15.Cancer and Population Studies GroupQueensland Institute of Medical Research, Bancroft CentreHerstonAustralia
  16. 16.University of Hawaii Cancer CenterHonoluluUSA
  17. 17.Cancer Prevention ProgramFred Hutchinson Cancer Research CenterSeattleUSA
  18. 18.Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesUSA
  19. 19.Department of Health Science ResearchMayo Clinic ArizonaScottsdaleUSA
  20. 20.Samuel Lunenfeld Research InstituteMount Sinai HospitalTorontoCanada
  21. 21.Cancer Care OntarioTorontoCanada

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