Karlitz Jordan J, Sherrill Meredith R, DiGiacomo Daniel V, Hsieh Mei-Chin, Schmidt Beth, Wu Xiao-Cheng, Chen Vivien W
Department of Medicine, Division of Gastroenterology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Clin Transl Gastroenterol. 2016 Apr 14;7(4):e163. doi: 10.1038/ctg.2016.17.
Early-onset colorectal cancer (CRC) incidence rates are rising. This group is susceptible to heritable conditions (i.e., Lynch syndrome (LS)) and inflammatory bowel disease (IBD) with high metachronous CRC rates after segmental resection. Hence, extended colonic resection (ECR) is often performed and considered generally in young patients. As there are no population-based studies analyzing resection extent in early-onset CRC, we used CDC Comparative Effectiveness Research (CER) data to assess state-wide operative practices.
Using CER and Louisiana Tumor Registry data, all CRC patients aged ≤50 years, diagnosed in Louisiana in 2011, who underwent surgery in 2011-2012 were retrospectively analyzed. Prevalence of, and the factors associated with operation type (ECR including subtotal/total/proctocolectomy vs. segmental resection) were evaluated.
Of 2,427 CRC patients, 274 were aged ≤50 years. In all, 234 underwent surgery at 53 unique facilities and 6.8% underwent ECR. Statistically significant ECR-associated factors included age ≤45 years, polyposis, synchronous/metachronous LS-associated cancers, and IBD. Abnormal microsatellite instability (MSI) was not ECR-associated. ECR was not performed in sporadic CRC.
ECR is performed in the setting of clinically obvious associated high-risk features (polyposis, IBD, synchronous/metachronous cancers) but not in isolated/sporadic CRC. However, attention must be paid to patients with seemingly lower risk characteristics (isolated CRC, no polyposis), as LS can still be present. In addition, the presumed sporadic group requires further study as metachronous CRC risk in early-onset sporadic CRC has not been well-defined, and some may harbor undefined/undiagnosed hereditary conditions. Abnormal MSI (LS risk) is not associated with ECR; abnormal MSI results often return postoperatively after segmental resection has already occurred, which is a contributing factor.
早发性结直肠癌（CRC）的发病率正在上升。这一群体易患遗传性疾病（即林奇综合征（LS））和炎症性肠病（IBD），在节段性切除术后异时性CRC发生率较高。因此，扩大结肠切除术（ECR）常在年轻患者中进行且被普遍考虑。由于尚无基于人群的研究分析早发性CRC的切除范围，我们使用疾病控制与预防中心（CDC）的比较效果研究（CER）数据来评估全州的手术实践。
利用CER和路易斯安那肿瘤登记数据，对2011年在路易斯安那州诊断出的、年龄≤50岁且在2011 - 2012年接受手术的所有CRC患者进行回顾性分析。评估手术类型（ECR包括次全/全/直肠结肠切除术与节段性切除术）的患病率及相关因素。
在2427例CRC患者中，274例年龄≤50岁。共有234例在53家不同的医疗机构接受了手术，6.8%的患者接受了ECR。与ECR相关的具有统计学意义的因素包括年龄≤45岁、息肉病、同步/异时性LS相关癌症以及IBD。微卫星不稳定性异常（MSI）与ECR无关。散发性CRC未进行ECR。
ECR在存在临床上明显的相关高危特征（息肉病、IBD、同步/异时性癌症）的情况下进行，但在孤立/散发性CRC中不进行。然而，对于风险特征看似较低的患者（孤立性CRC，无息肉病）必须予以关注，因为仍可能存在LS。此外，假定的散发性群体需要进一步研究，因为早发性散发性CRC的异时性CRC风险尚未明确界定，且一些患者可能存在未明确/未诊断的遗传性疾病。MSI异常（LS风险）与ECR无关；MSI异常结果通常在节段性切除术后才返回，这是一个促成因素。
