Pasqualotto Eric, Pompeu Bernardo Fontel, Braga Marcelo A P, Delgado Lucas Monteiro, Chavez Matheus Pedrotti, Morgado Ferreira Rafael Oliva, Pasqualotto Tales, Morbach Victória, Formiga Fernanda Bellotti
Universidade Federal de Santa Catarina, Florianópolis, Brazil.
Hospital Heliópolis, São Paulo, Brazil.
World J Surg. 2025 Jan;49(1):24-33. doi: 10.1002/wjs.12443. Epub 2024 Dec 4.
The decision to perform segmental or extended colectomy in Lynch syndrome (LS) patients with colorectal cancer (CRC) is still controversial. Therefore, this systematic review and meta-analysis aims to provide updated evidence for segmental versus extended colectomy in LS carriers with CRC.
PubMed, Embase, and Cochrane Library were systematically searched for studies published until January 2024 comparing segmental and extended colectomies for CRC in patients with LS. Risk ratio (RR) was used to evaluate binary endpoints with 95% confidence intervals (CIs). Heterogeneity was assessed with the Cochran's Q test and I statistics. Statistical analysis was performed using the R Software, version 4.2.3.
A total of 14 studies comprising 2303 LS carriers with CRC, of whom 1724 (74.9%) patients underwent segmental colectomy and 579 (25.1%) patients underwent extended colectomy. Segmental colectomy significantly increased metachronous CRC (mCRC) (RR 2.87; 95% CI 2.03-4.07; and p < 0.01). There were no significant differences between groups for 5-year overall survival (OS) (RR 0.92; 95% CI 0.82-1.03; and p = 0.14), 10-year OS (RR 0.99; 95% CI 0.96-1.04; and p = 0.80), and mortality (RR 1.63; 95% CI 0.90-2.97; and p = 0.11). There were no significant linear associations between the outcome of mCRC and age at the time of primary CRC, sex, primary CRC location, and pathogenic LS variant.
In this meta-analysis, segmental colectomy significantly increased mCRC compared with extended colectomy after the first surgery for CRC in patients with LS. However, there were no significant differences between groups for 5- and 10-year OS and mortality.
对于患有结直肠癌（CRC）的林奇综合征（LS）患者，决定进行节段性或扩大性结肠切除术仍存在争议。因此，本系统评价和荟萃分析旨在为LS携带者合并CRC患者行节段性与扩大性结肠切除术提供最新证据。
系统检索了PubMed、Embase和Cochrane图书馆中截至2024年1月发表的比较LS患者CRC节段性和扩大性结肠切除术的研究。风险比（RR）用于评估二元终点，并给出95%置信区间（CI）。采用Cochran's Q检验和I统计量评估异质性。使用R软件4.2.3版进行统计分析。
共有14项研究，纳入2303例患有CRC的LS携带者，其中1724例（74.9%）患者接受了节段性结肠切除术，579例（25.1%）患者接受了扩大性结肠切除术。节段性结肠切除术显著增加了异时性CRC（mCRC）（RR 2.87；95%CI 2.03 - 4.07；p < 0.01）。两组在5年总生存率（OS）（RR 0.92；95%CI 0.82 - 1.03；p = 0.14）、10年OS（RR 0.99；95%CI 0.96 - 1.04；p = 0.80）和死亡率（RR 1.63；95%CI 0.90 - 2.97；p = 0.11）方面无显著差异。mCRC的结局与初次CRC时的年龄、性别、原发性CRC位置和致病性LS变异之间无显著线性关联。
在这项荟萃分析中，对于LS患者CRC首次手术后，与扩大性结肠切除术相比，节段性结肠切除术显著增加了mCRC。然而，两组在5年和10年OS及死亡率方面无显著差异。
