Center for Colorectal Cancer, National Cancer Center, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
Int J Colorectal Dis. 2020 Jul;35(7):1273-1282. doi: 10.1007/s00384-020-03583-1. Epub 2020 Apr 21.
The high incidence of metachronous colorectal tumours in patients with hereditary non-polyposis colorectal cancer (HNPCC) encourages extended resection (ER); however, the optimal surgical approach remains unclear. We evaluated the incidences of metachronous colorectal neoplasms following curative colorectal cancer segmental resection (SR) vs ER in patients with HNPCC and investigated patients' oncologic outcomes according to surgical modality and mismatch repair status.
We retrospectively investigated medical records of patients with HNPCC (per the Amsterdam II criteria) treated for primary colon cancer at our institution between 2001 and 2017. All patients underwent intensive endoscopic surveillance.
We included 87 patients (36 who underwent SR and 51 who underwent ER). The cumulative incidence of metachronous adenoma was higher in the SR group. One patient in the SR group (2.8%) and 3 in the ER group (5.9%) developed metachronous colon cancer; the difference was not significant (P = 0.693). Four patients in the SR group (11.1%) and 1 in the ER group (2.0%) developed distant recurrences; again, the difference was not significant (P = 0.155). Moreover, no significant differences were observed in the 5-year overall survival rates of patients in the SR and ER groups (88.2% vs 95.5%, P = 0.446); the same was true for 5-year disease-free survival rates (79.5% vs 91.0%, P = 0.147).
The incidence of metachronous cancer was not significantly different between the ER and SR groups; however, that of cumulative metachronous adenoma was higher in the SR group. Hence, intensive surveillance colonoscopy may be sufficient for patients with HNPCC after non-extensive colon resection.
遗传性非息肉病性结直肠癌（HNPCC）患者结直肠肿瘤的继发率较高，这鼓励进行扩大切除术（ER）；然而，最佳手术方式仍不明确。我们评估了 HNPCC 患者接受结直肠癌根治性节段切除术（SR）与 ER 后结直肠新发肿瘤的发生率，并根据手术方式和错配修复状态调查了患者的肿瘤学结局。
我们回顾性调查了 2001 年至 2017 年在我院接受原发性结肠癌治疗的 HNPCC 患者（符合阿姆斯特丹 II 标准）的病历。所有患者均接受了强化内镜监测。
我们纳入了 87 例患者（SR 组 36 例，ER 组 51 例）。SR 组的继发腺瘤累积发生率较高。SR 组中有 1 例（2.8%）和 ER 组中有 3 例（5.9%）患者发展为继发结肠癌，但差异无统计学意义（P=0.693）。SR 组中有 4 例（11.1%）和 ER 组中有 1 例（2.0%）患者发生远处复发，差异也无统计学意义（P=0.155）。此外，SR 组和 ER 组患者的 5 年总生存率（88.2% vs 95.5%，P=0.446）和 5 年无病生存率（79.5% vs 91.0%，P=0.147）均无显著差异。
ER 组和 SR 组的继发癌发生率无显著差异；然而，SR 组的累积性继发腺瘤发生率较高。因此，对于非广泛结肠切除术后的 HNPCC 患者，强化监测结肠镜检查可能就足够了。
