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Survival Outcome and Risk of Metachronous Colorectal Cancer After Surgery in Lynch Syndrome

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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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Disclosure

Tae Jun Kim, Eun Ran Kim, Sung Noh Hong, Young-Ho Kim, Jung Wook Huh, Yoon Ah Park, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Woo Yong Lee, Kiyoun Kim, Kyunga Kim, and Dong Kyung Chang have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Tae Jun Kim MD, Eun Ran Kim MD, Sung Noh Hong MD, PhD, Young-Ho Kim MD, PhD & Dong Kyung Chang MD, PhD

  2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jung Wook Huh MD, PhD, Yoon Ah Park MD, Yong Beom Cho MD, PhD, Seong Hyeon Yun MD, PhD, Hee Cheol Kim MD, PhD & Woo Yong Lee MD, PhD

  3. Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Kiyoun Kim MS & Kyunga Kim PhD

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  1. Tae Jun Kim MD
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  2. Eun Ran Kim MD
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  3. Sung Noh Hong MD, PhD
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  4. Young-Ho Kim MD, PhD
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  7. Yong Beom Cho MD, PhD
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  8. Seong Hyeon Yun MD, PhD
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  11. Kiyoun Kim MS
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  13. Dong Kyung Chang MD, PhD
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Corresponding author

Correspondence to Dong Kyung Chang MD, PhD.

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Kim, T.J., Kim, E.R., Hong, S.N. et al. Survival Outcome and Risk of Metachronous Colorectal Cancer After Surgery in Lynch Syndrome. Ann Surg Oncol 24, 1085–1092 (2017). https://doi.org/10.1245/s10434-016-5633-1

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  • DOI: https://doi.org/10.1245/s10434-016-5633-1

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