Nagasaki Toshiya, Arai Masami, Chino Akiko, Akiyoshi Takashi, Fukunaga Yosuke, Ueno Masashi
Departments of Gastroenterological Surgery, Tokyo, Japan.
Departments of Clinical Genetic Oncology, Tokyo, Japan.
Dig Surg. 2018;35(5):448-456. doi: 10.1159/000481413. Epub 2017 Oct 10.
Initial surgical procedures for colorectal cancer (CRC) patients with Lynch syndrome remain controversial. This study assessed the validity of segmental colectomy (SGC) followed by endoscopic surveillance as a treatment strategy for CRC patients with Lynch syndrome.
Among consecutive patients who underwent surgery for primary CRC between April 1985 and December 2014, 49 patients were observed to have germline mutations in a mismatch repair gene, and 38 patients who underwent SGC followed by periodic endoscopic surveillance at our institution were evaluated for metachronous CRC, need for secondary surgery, and the details of endoscopic surveillance.
Of the 38 patients who underwent SGC followed by periodic endoscopic surveillance at our institution, 6 (15.8%) patients showed metachronous CRC, 3 (7.9%) patients underwent endoscopic resection, and the other 3 patients (7.9%) underwent secondary surgery. The dispersion of the endoscopic surveillance interval was significantly greater in patients with metachronous CRC (364 ± 332.9 days) than in those without metachronous CRC (370 ± 129.7 days; p < 0.001).
SGC followed by annual endoscopic surveillance was feasible as a treatment strategy for CRC patients with Lynch syndrome, because the incidence of metachronous CRC and the need for secondary surgery were low. Annual and periodic endoscopic surveillance might be essential for early detection of metachronous CRC and prevention of secondary surgery because of metachronous CRC in CRC patients with Lynch syndrome after SGC.
林奇综合征结直肠癌（CRC）患者的初始手术方式仍存在争议。本研究评估了节段性结肠切除术（SGC）联合内镜监测作为林奇综合征CRC患者治疗策略的有效性。
在1985年4月至2014年12月期间接受原发性CRC手术的连续患者中，观察到49例患者存在错配修复基因的胚系突变，对在我们机构接受SGC并定期进行内镜监测的38例患者进行了异时性CRC、二次手术需求及内镜监测细节的评估。
在我们机构接受SGC并定期进行内镜监测的38例患者中，6例（15.8%）出现异时性CRC，3例（7.9%）接受了内镜切除，另外3例（7.9%）接受了二次手术。出现异时性CRC的患者内镜监测间隔的离散度（364±332.9天）显著大于未出现异时性CRC的患者（370±129.7天；p<0.001）。
SGC联合每年一次的内镜监测作为林奇综合征CRC患者的治疗策略是可行的，因为异时性CRC的发生率和二次手术的需求较低。对于SGC术后的林奇综合征CRC患者，每年定期进行内镜监测对于早期发现异时性CRC及预防因异时性CRC而进行二次手术可能至关重要。
