Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Ann Surg. 2012 Jun;255(6):1121-5. doi: 10.1097/SLA.0b013e3182565c0b.
To define the neoplastic risk in the remaining colon after proctectomy for rectal cancer in patients with hereditary nonpolyposis colorectal cancer (HNPCC).
The extent of surgery for rectal cancer in HNPCC is controversial. In determining which operation to perform, surgeons and patients must consider cancer risk in the remaining colon as well as functional consequences of removing the entire colorectum. The natural history of colon neoplasia in this situation is understudied and is not well-defined.
A single-institution hereditary colorectal cancer database was queried for patients meeting Amsterdam criteria and with rectal cancer. Patient demographics, surgical management, and follow-up were recorded.
Fifty HNPCC patients with a primary diagnosis of rectal cancer treated by proctectcomy were included. Detailed follow-up colonoscopy data were available for 33 patients. Forty-eight high-risk adenomas developed in 13 patients (39.4%). Five patients (15.2%) developed metachronous adenocarcinoma at a median of 6 years (range 3.5-16) after proctectomy, including 3 at advanced stage. One of these patients developed a high-risk adenoma before cancer. Mean interval between the last normal colonoscopy and cancer discovery was 42 months (range 23.8-62.1) with one developing within 2 years. Thus, 17 of 33 patients (51.5%) developed high-risk adenoma or cancer after proctectomy.
Surgeons and patients need to be aware of substantial risk for metachronous neoplasia after proctectomy. Selection of operation should be individualized, but total proctocolectomy and ileoanal pouch should be strongly considered. If patients undergo proctectomy alone, close surveillance is mandatory.
定义遗传性非息肉病性结直肠癌（HNPCC）患者因直肠癌行直肠切除术后残留结肠的肿瘤风险。
HNPCC 中直肠癌的手术范围存在争议。在确定进行哪种手术时，外科医生和患者必须考虑残留结肠的癌症风险以及切除整个结直肠的功能后果。这种情况下结肠肿瘤的自然史研究较少，也没有明确的定义。
通过单机构遗传性结直肠癌数据库查询符合阿姆斯特丹标准且患有直肠癌的患者。记录患者的人口统计学、手术管理和随访情况。
纳入 50 例因直肠肿瘤而行直肠切除的 HNPCC 患者。33 例患者详细的随访结肠镜检查数据可用。13 例患者（39.4%）共发生 48 个高危腺瘤。5 例患者（15.2%）在直肠切除后中位 6 年（范围 3.5-16 年）时发生了同时性腺癌，其中 3 例为晚期。这些患者中有 1 例在癌症发生前发现了高危腺瘤。最后一次正常结肠镜检查和癌症发现之间的平均间隔为 42 个月（范围 23.8-62.1），其中 1 例在 2 年内发生。因此，33 例患者中有 17 例（51.5%）在直肠切除术后发生了高危腺瘤或癌症。
外科医生和患者需要意识到直肠切除术后存在明显的同时性肿瘤风险。手术选择应个体化，但应强烈考虑全直肠结肠切除术和回肠肛管吻合术。如果患者仅接受直肠切除术，必须进行密切监测。
