Colorectal Unit, Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
Colorectal Dis. 2011 Dec;13(12):1395-9. doi: 10.1111/j.1463-1318.2010.02467.x.
The high reported risk of metachronous colon cancer (MCC) in hereditary nonpolyposis colorectal cancer (HNPCC) has led some authors to recommend total colectomy (TC) as the preferred operation for primary colon cancer, but this remains controversial. No previous study has compared survival after TC with segmental colectomy (SC) in HNPCC. The aim of this study was to determine the risk of developing MCC in patients with genetically proven HNPCC after SC or TC for cancer, and to compare their long-term survival.
This is a prospective cohort study of all patients referred to our unit between 1995 and 2009 with a proven germline mismatch repair gene defect, who had undergone a resection for adenocarcinoma of the colon with curative intent. All patients were offered annual endoscopic surveillance.
Of 60 patients in the study, 39 had TC as their initial surgery and 21 had SC. After 6 years follow up, MCC occurred in eight (21%) SC patients and in none of the TC patients (P = 0.048). The risk of developing MCC after SC was 20% at 5 years. Colorectal cancer-specific survival was better in TC patients (P = 0.048) but overall survival of the two groups was similar (P = 0.29).
Patients with HNPCC have a significant risk of MCC after SC. This is eliminated by performing TC as the primary operation for colonic cancer.
遗传性非息肉病性结直肠癌（HNPCC）中报告的结直肠癌异时性（MCC）风险较高，导致一些作者建议对原发性结肠癌首选全结肠切除术（TC），但这仍然存在争议。以前没有研究比较过 HNPCC 患者接受 TC 与节段性结肠切除术（SC）后的生存情况。本研究旨在确定在因癌症接受 SC 或 TC 治疗后，经基因证实的 HNPCC 患者中发生 MCC 的风险，并比较其长期生存情况。
这是一项前瞻性队列研究，纳入了 1995 年至 2009 年期间因遗传性错配修复基因缺陷而转诊至我们科室的所有患者，这些患者均接受了根治性结肠癌切除术。所有患者均接受年度内镜监测。
在 60 名研究患者中，39 名患者初始手术为 TC，21 名患者为 SC。随访 6 年后，8 名（21%）SC 患者发生 MCC，而 TC 患者无一例发生（P = 0.048）。SC 后 5 年内发生 MCC 的风险为 20%。TC 患者的结直肠癌特异性生存率更好（P = 0.048），但两组的总生存率相似（P = 0.29）。
HNPCC 患者在接受 SC 后发生 MCC 的风险显著增加。对结肠癌症行 TC 作为主要手术可消除这种风险。
