Risk of metachronous colorectal cancer after surgical resection of index rectal cancer in Lynch syndrome: a multicenter retrospective study in Japan

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2024年3月19日

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Kenichi Chikatani,
Hideyuki Ishida,
Yoshiko Mori,
Takeshi Nakajima,
Arisa Ueki,
Kiwamu Akagi,
Akinari Takao,
Masayoshi Yamada,
Fumitaka Taniguchi,
Koji Komori,
Kazuhito Sasaki,
Tomoya Sudo,
Yasuyuki Miyakura,
Akiko Chino,
Tatsuro Yamaguchi,
Kohji Tanakaya,
Naohiro Tomita,
Yoichi Ajioka

摘要

Purpose

This study evaluated the risk of metachronous colorectal cancer (CRC) after resection of index (first) rectal cancer in patients with Lynch syndrome (LS).

Methods

Clinicopathological data of patients with genetically proven LS were retrospectively analyzed in this multicenter Japanese study. The cumulative incidence of metachronous CRC and the overall survival were compared between patients with index rectal cancer (rectal group) and those with index colon cancer (colon group).

Results

The median age at index CRC surgery was lower in the rectal group than in the colon group (37 vs. 46 years old, P = 0.01). The cumulative 5-, 10-, and 20-year incidences of metachronous CRC were 3.5%, 13.9%, and 21.1%, respectively, in the rectal cancer group and 14.9%, 22.0%, and 57.9%, respectively, in the colon cancer group (P = 0.02). The overall survival curves were not significantly different between two groups (P = 0.23).

Conclusion

This is the first report from an East Asian country to report the risk of metachronous CRC after resection of index rectal cancer in patients with LS. Despite this study having several limitations, we cannot recommend extended resection, such as total proctocolectomy, for index rectal cancer as a standard surgical treatment in patients with LS.