Hereditary nonpolyposis colorectal cancer surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]Ali Akram, M.B.B.S.[3]

Surgery is the mainstay of treatment for hereditary nonpolyposis colorectal cancer. Surgical resection is recommended for patients with hereditary nonpolyposis colorectal cancer because of the high rate of metachronous colorectal cancer. Subtotal colectomy with ileo–rectal anastomosis and postsurgical endoscopic rectal surveillance are advised when colorectal cancer develops in the setting of hereditary nonpolyposis colorectal cancer.

• Surgical resection is recommended for patients with hereditary nonpolyposis colorectal cancer because of the high rate of metachronous colorectal cancer.
• Common surgical techniques for the resection of hereditary nonpolyposis colorectal cancer include:

• Subtotal colectomy with ileo–rectal anastomosis and postsurgical endoscopic rectal surveillance (surgical treatment of choice in the setting of hereditary nonpolyposis colorectal cancer)
• Proctocolectomy with ileostomy
• Colectomy with ileo–rectal anastomosis and/or proctocolectomy with ileo-anal “pouch“^[1]
• Proctocolectomy with ileostomy
• Colectomy with ileo–rectal anastomosis
• Proctocolectomy with ileo-anal “pouch” S, J, W or H^[1]
• Hysterectomy and adnexectomy (in female hereditary nonpolyposis colorectal cancer patients) due to increased risk of primary endometrial and ovarian cancers
• Endoscopic polypectomy (recommended in the case of polyps which are benign and non-recurrent)

• Surgical procedures for hereditary nonpolyposis colorectal cancer are characterized by increasing frequency of complications.
• Complex surgical procedures are related with higher number of complications, but lower recurrence rates.
• Prophylactic colectomy should be considered in patients with adenomas that are multiple and/or recurrent and/or of a significant degree of dysplasia and/or villous.
• The high proportion of synchronous tumors (more than 15% of patients at the time of diagnosis) or metachronous tumors (about 45% during 10 years following surgery of the primary tumor) indicates preventive surgery as for surgery in patients of hereditary nonpolyposis colorectal cancer.^[1]

Common surgical complications of hereditary nonpolyposis colorectal cancer may include:

• Urinary tract abnormalities
• Sexual dysfunction

• The feasibility of prophylactic surgery of the colon, uterus, and ovaries varies from patient to patient.^[2]
• In some cases screen-detected family members and symptomatic individuals (young adults) are eligible for prophylactic colorectal surgery.

• Prophylactic surgery should not be recommended for patients without any pathological changes in the colon even if such individuals are carriers of a mutation.^[3]

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