A Lynch syndrome patient (MLH1 mutation) is diagnosed with a 2.5 cm carcinoma in the ascending colon. She is 35 years old. What is the most appropriate surgical option and surveillance recommendation?
- A Extended right hemicolectomy or subtotal colectomy with ileorectal anastomosis, with annual colonoscopy of remaining colon ✓
- B Right hemicolectomy with annual colonoscopy
- C Right hemicolectomy and prophylactic hysterectomy with bilateral salpingo-oophorectomy simultaneously
- D Segmental resection only; surveillance colonoscopy every 5 years
Explanation
In young Lynch syndrome patients, the metachronous colorectal cancer risk after segmental resection is high (15–20% at 10 years). Extended right hemicolectomy or subtotal colectomy with ileorectal anastomosis is recommended to reduce the risk of metachronous cancer in the remaining colon while preserving anorectal function. Annual colonoscopy of the remaining colon/rectum is essential. Prophylactic gynecological surgery may be discussed separately but is not standard simultaneous practice unless the patient is fully counselled and consents. The NCCN Lynch syndrome guidelines endorse subtotal colectomy in young patients where compliance with surveillance may be uncertain.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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