Cancer in Lynch syndrome: which operation?
Bearing in mind that the incidence of Lynch syndrome may be higher that expected (up to 1 out of every 300 hundred persons), the importance of this genetic syndrome lies in the fact that it increases the risk of colorectal cancer by up to 70%. Prof. Clark emphasizes that decision-making in Lynch syndrome can be determined by increased risk of metachronous colorectal cancer as well as by the enhanced colonoscopic surveillance required. Metachronous cancer in Lynch syndrome accounts for 20% of cases, equal to a 4-fold increase. As there is a gene-specific risk, incidence may vary on the basis of the genetic mutation. Additionally, the CAPP study showed that patients receiving aspirin would decrease their risk by half. Studies have showed measurable compromises in long-term bowel function after extended vs. segmental colectomies. Functional outcomes are essential when deciding, as extended colectomies add additional defecations per day, and are less well tolerated in the elderly. Regarding quality of life, studies disagree on whether there are differences between extended vs. segmental. Deciding between low anterior resection, ileorectal anastomosis, panproctocolectomy or a pouch should be patient-tailored, considering the pros and cons of each operation. Guidelines describe molecular testing for patients and may help in decision-making. If diagnosis is suspected but not genetically confirmed, extended resections are not recommended. In summary, the decision should be individualized according to patient factors, tumor location, genetic testing, and access to surveillance.
