Anele C C, Adegbola S O, Askari A, Rajendran A, Clark S K, Latchford A, Faiz O D
Department of Surgery and Cancer, Imperial College London, London, UK.
St Mark's Hospital and Academic Institute, Middlesex, UK.
Colorectal Dis. 2017 Jun;19(6):528-536. doi: 10.1111/codi.13679.
Lynch syndrome (LS) accounts for 2-4% of all colorectal cancer (CRC) cases, and is associated with an increased risk of developing metachronous colorectal cancer (mCRC). The role of extended colectomy in LS CRC is controversial. There are limited studies comparing the risk of mCRC following segmental colectomy and extended colectomy. The objective of this systematic review is to evaluate the risk of developing mCRC following segmental and extended colectomy for LS CRC and endoscopic compliance.
A systematic review of major databases was performed using predefined terms. All original articles published in English comparing the risk of mCRC in LS patients after segmental and extended colectomy from 1950 to January 2016 were included.
The search retrieved 324 studies. Six studies involving 871 patients met the inclusion criteria. Of these, 705 (80.9%) underwent segmental colectomy and 166 (19.1%) extended colectomy. Average follow-up was 91.2 months. The mCRC rate was 22.8% and 6% in the segmental and extended colectomy groups, respectively. The segmental group were over four times more likely to develop mCRC (OR 4.02, 95% CI: 2.01-8.04, P < 0.0001). mCRC occurred in patients after segmental colectomy despite 1-2-yearly postoperative endoscopic surveillance.
This result suggests that extended colectomy reduces the risk of mCRC by over four-fold compared with segmental colectomy. mCRC occurred in the segmental group despite postoperative endoscopic surveillance. This needs to be borne in mind when deciding on the appropriate surgical management of LS patients with CRC. We recommend that extended colectomy should be considered for patients with confirmed LS CRC.
林奇综合征（LS）占所有结直肠癌（CRC）病例的2%-4%，并与异时性结直肠癌（mCRC）发生风险增加相关。扩大性结肠切除术在LS相关CRC中的作用存在争议。比较节段性结肠切除术和扩大性结肠切除术之后mCRC风险的研究有限。本系统评价的目的是评估节段性和扩大性结肠切除术治疗LS相关CRC后发生mCRC的风险以及内镜检查的依从性。
使用预定义术语对主要数据库进行系统评价。纳入所有1950年至2016年1月期间发表的比较LS患者节段性和扩大性结肠切除术后mCRC风险的英文原创文章。
检索到324项研究。六项涉及871例患者的研究符合纳入标准。其中，705例（80.9%）接受节段性结肠切除术，166例（19.1%）接受扩大性结肠切除术。平均随访时间为91.2个月。节段性和扩大性结肠切除术组的mCRC发生率分别为22.8%和6%。节段性结肠切除术组发生mCRC的可能性是扩大性结肠切除术组的四倍多（比值比4.02，95%置信区间：2.01-8.04，P<0.0001）。尽管术后每年进行1-2次内镜监测，但节段性结肠切除术后患者仍发生了mCRC。
该结果表明，与节段性结肠切除术相比，扩大性结肠切除术可将mCRC风险降低四倍以上。尽管进行了术后内镜监测，但节段性结肠切除术组仍发生了mCRC。在决定LS相关CRC患者的合适手术治疗方案时，需要牢记这一点。我们建议，确诊为LS相关CRC的患者应考虑行扩大性结肠切除术。
