Segmental Instead of Total Colectomy in Colon Cancer Patients Meeting Amsterdam Criteria: It’s Not Worth the Metachronous Risk
*Matthew F Kalady, *Ellen McGannon, *Jon D. Vogel, *Susan Fay, Victor W Fazio, James M. Church
Cleveland Clinic, Cleveland, OH
OBJECTIVE(S): Due to the nearly 80% lifetime colorectal cancer risk of patients meeting Amsterdam criteria for diagnosis of Hereditary Nonpolyposis Colorectal Cancer, a total rather than segmental resection to reduce the risk of metachronous colorectal cancer is advocated. The effectiveness of surveillance after segmental colectomy in preventing subsequent cancer is not well-documented. This study examines the results of such surveillance.
METHODS: A hereditary colorectal cancer database was reviewed for patients meeting Amsterdam criteria who underwent colectomy for cancer. Patient demographics, surgical management, and subsequent follow-up were recorded. The primary endpoints were subsequent adenoma formation and second cancer development.
RESULTS: 311 patients were included, 79 treated primarily at our institution and 232 referred to our registry after index resection. 157 cancers were right-sided. Mean age at index surgery was 52 years. 254 patients underwent a segmental colectomy of which 191 had documented colonoscopic surveillance. 105 of 191 (55%) had subsequent polypectomy, with removal of 198 adenomas including 95 that were high-risk by size or histology criteria. 51 of 191 (27%) segmental colectomy patients subsequently developed colorectal cancer at mean 120 months after index surgery. Stages at second resection were I-21, II-16, III-14. Five of 57 patients (8.8%) who underwent total colectomy developed subsequent cancer.
CONCLUSIONS: Amsterdam patients undergoing partial colectomy have a high rate of metachronous high-risk adenomas and cancers, including advanced stage. Total colectomy for the index cancer remains the procedure of choice. If patients have an initial segmental colectomy, yearly surveillance is essential, with intervention to prevent metachronous cancer.