Volume 9 Supplement 1

Proceedings of the 14th Annual Meeting of the Collaborative Group of the Americas on Inherited Colorectal Cancer

Open Access

Post-surgical surveillance in Lynch syndrome--a Cleveland Clinic experience

Hereditary Cancer in Clinical Practice20119(Suppl 1):P13

https://doi.org/10.1186/1897-4287-9-S1-P13

Published: 10 March 2011

Background

Post-surgical colonoscopic surveillance is recommended every 1-2 years for patients diagnosed with colon cancer and Lynch syndrome. Patients electing to have a segmental versus colectomy IRA risk developing metachronous colon cancers. The rationale for frequent surveillance is to detect and remove polyps before pathologically advancing to cancer thereby reducing mortality. Does compliance with recommended surveillance eliminate the risk of metachronous cancers?

Method

A database search for MMR+ families enrolled in the Jagelman Inherited Colorectal Cancer Registry was performed. Patients suitable for this study were status post surgery for colon cancer with the surgery and post operative follow-ups being performed at the Cleveland Clinic.

Results

22 patients in 16 families were identified as meeting criteria described above. All but 2 patients are living. One cause of death was advanced colon cancer; the other non-cancer related. Sixteen (64%) segmental resections or hemicolectomies were performed in 14 patients, 3 of the 14 patients had a second surgery for metachronous colon cancer. Colectomy IRAs were performed in 9 patients (36%). Surgeries dated from 1978 to 2010. Collectively, 82 follow-up (FU) colonoscopy, sigmoidoscopy or proctoscopy exams were performed (range 1-9/patient). The interval between surgery and first FU or subsequent FUs totaled 163 years (range 1-22; mean=6.8; median=5). No polyps or cancers were detected in patients having a colectomy IRA. Polyps were detected in 12 out of the 14 (86%) patients who had segmental resections. An analysis of polyp and cancer incidence in patients having segmental resection is shown in Table 1. Figure 1 shows the point within and outside the 1-2 year recommended surveillance period pathologically advanced polyps and cancers were detected.
Table 1

Incidence of polyps and cancer following segmental resection

#FU Exams

#FU exams detected polyps

#FU exams detected pathologically advanced polyps*

#FU exams detected cancers

Interval between FU & polyp detected (range= 0.5–4.5 yrs)

Interval between FU & cancer detected (range= 0.5-3 yrs)

52

25 (48%)

7 (13%)

4 (8%)

Mean= 1.5yr

Median= 1yr

Mean= 1.4yr

Median= 1yr

*pathologically advanced polyp is described as an adenoma being 1cm or larger, having a villous component, or high-grade or severe dysplasia.

Figure 1

Further analysis indicates that if a polyp is detected in a FU exam, it is 28% likely to be pathologically advanced and 16% likely to be cancer.

Conclusion

  1. 1.

    Compliance with post surgical surveillance guidelines does not eliminate risk of metachronous cancers.

     
  2. 2.

    Pathologically advanced polyps and cancers can occur within 1 year status post segmental resection.

     

Authors’ Affiliations

(1)
Taussig Cancer Institute, Sanford R. Weiss, M.D. Center of Hereditary Colorectal Neoplasia, Cleveland Clinic
(2)
Colorectal Surgery Department, Digestive Disease Institute, Sanford R. Weiss, M.D. Center of Hereditary Colorectal Neoplasia, Cleveland Clinic

Copyright

© Fay et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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