Choosing the Best Colon Surgery for Lynch Syndrome

Removing the entire colon (subtotal colectomy) is sometimes recommended for patients with Lynch syndrome when colon cancer is diagnosed.  In addition, some people who have an inherited Lynch mutation have their colons removed to prevent colon cancer.

While subtotal colectomy didn’t reduce deaths from Lynch-related colon cancer, it did cut down on additional colorectal cancer diagnoses and the need for other abdominal surgery.

Five years after surgery, 93 percent of patients who had subtotal colectomy were alive compared to 88 percent of those who had more limited operations or no surgery.  This wasn’t a significant difference.  However, 84 percent survived the five years without needing additional abdominal surgery compared to 63 percent of the group who had limited or no surgery.

Researchers analyzed people with Lynch syndrome in the Creighton University database.  Cases included those who had subtotal colectomy, either at the time of colon cancer diagnosis or as preventive surgery. They were compared to controls who had limited operations to remove only part of the colon (segmental colectomy).

In subtotal colectomy the colon is removed and the small intestine is attached to the rectum, which remains in place.

Five years after surgery, comparing those who had subtotal colectomy to those with limited resection:

• 94 percent were alive without another colorectal cancer compared to 74 percent of the controls alive and without subsequent colorectal cancer.
• 84 percent survived without needing abdominal surgery compared to 63 percent of controls.
• 93 percent lived five years compared to 88 percent of controls.
• Time to another colorectal cancer or the need for abdominal surgery was shorter for those who had a limited resection.

Their conclusion:

Even though no survival benefit was identified between the cases and controls the increased incidence of metachronous colorectal cancer and increased abdominal surgeries among controls warrant the recommendation of subtotal colectomy in patients with Lynch syndrome.

Lynch syndrome is a highly increased risk for colorectal and other related cancers caused by an inherited mutation in one of the mismatch repair genes.  People with a Lynch syndrome genetic mutation have a lifetime risk for colorectal cancer as high as 80 percent.

SOURCE: Natarajan et al., Diseases of the Colon and Rectum, Volume 53, Issue 1, pages 72-82, January 2010.