林奇综合征突变携带者右侧首发性结直肠癌的外科治疗中近端结肠切除术的疗效。
Efficacy of proximal colectomy for surgical management of right-sided first colorectal cancer in Lynch Syndrome mutation carriers.
机构信息
Creighton Hereditary Cancer Center, Department of Preventive Medicine and Public Health, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA; Department of Obstetrics and Gynecology, Gynecologic Oncology, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA.
Creighton Hereditary Cancer Center, Department of Preventive Medicine and Public Health, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA; Department of Obstetrics and Gynecology, Gynecologic Oncology, Creighton University, School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA.
出版信息
Am J Surg. 2018 Jul;216(1):99-105. doi: 10.1016/j.amjsurg.2017.11.003. Epub 2017 Nov 8.
BACKGROUND
This study analyzes the occurrence of colorectal cancer (CRC) in Lynch syndrome (LS) mutation carriers, interval until diagnosis of metachronous CRC, and survival after proximal colectomy (PC) compared with total (TC) and subtotal colectomy (STC) for right-sided first CRC in LS mutation carriers.
METHODS
Sixty-four LS mutation carriers with right-sided first CRC treated with PC or TC + STC were confirmed by clinical records. Bivariate analyses were examined for significance and life tables were generated for risk of metachronous CRC and survival estimates following surgery.
RESULTS
One of 16 (6.3%) mutation carriers treated with TC + STC developed subsequent CRC compared with 13/48 (27%) treated by PC. There was no significant difference in survival estimates between PC compared with TC + STC through 25 years after surgery.
CONCLUSION
Risk of subsequent CRC and survival estimates following PC and TC + STC should be considered in surgical management of right-sided first CRC in LS mutation carriers.
背景
本研究分析了林奇综合征（LS）突变携带者中结直肠癌（CRC）的发生、诊断为异时性 CRC 的间隔时间，以及与右半侧首发 CRC 的 LS 突变携带者接受全结肠切除术（PC）与结肠次全切除术（TC+STC）相比，接受近端结肠切除术（PC）后的生存情况。
方法
通过临床记录证实了 64 名接受 PC 或 TC+STC 治疗的右半侧首发 CRC 的 LS 突变携带者。对双变量分析进行了显著性检验，并生成了生存表，以评估异时性 CRC 的风险和手术后的生存估计。
结果
在接受 TC+STC 治疗的 16 名突变携带者中，有 1 名（6.3%）发生了随后的 CRC，而接受 PC 治疗的 48 名突变携带者中有 13 名（27%）发生了随后的 CRC。PC 与 TC+STC 相比，手术后 25 年内的生存估计值无显著差异。
结论
在 LS 突变携带者的右半侧首发 CRC 的手术治疗中，应考虑接受 PC 和 TC+STC 后的异时性 CRC 风险和生存估计值。
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