Less is more: rethinking colorectal cancer resection strategies in Lynch syndrome
Menée à l'aide de données néerlandaises portant sur 527 patients atteints du syndrome de Lynch (âge moyen : 48,7 ans ; 52 % d'hommes), cette étude analyse le risque de cancer colorectal métachrone (121 cas) après une colectomie partielle ou étendue en fonction de la présence de variants pathogènes
Lynch syndrome, resulting from a pathogenic germline variant in MLH1, MSH2, MSH6, PMS2, or EPCAM, is the most common hereditary colorectal cancer predisposition syndrome. 1 Compared with a 4% lifetime risk of colorectal cancer in the general population, Lynch syndrome associated with MLH1, MSH2, or EPCAM variants confers up to a 60% lifetime risk of colorectal cancer. 2 The markedly lower colorectal cancer risk in carriers of MSH6 and PMS2 variants has led to gene-specific recommendations, including later age at first colonoscopy initiation and consideration of a longer surveillance interval in these patients. 2 Factors, such as family cancer history or social and behavioural exposures, might further add to the variability in the colorectal cancer risk associated with Lynch syndrome. 3 Acknowledging this substantial variability in colorectal cancer risk, when patients with Lynch syndrome are diagnosed with colorectal cancer, the surgical approach, specifically whether a partial (segmental) resection or an extensive (subtotal or total) resection is undertaken, is an important and increasingly nuanced decision. Whereas extensive colectomy reduces the risk of metachronous colorectal cancer compared with partial colectomy, a survival benefit has not been shown 4 , 5 and extensive colectomy is associated with worse functional outcomes. 6 Therefore, determining the optimal surgical approach for patients with Lynch syndrome and colorectal cancer warrants important further consideration.