A 45-year-old man with Lynch syndrome (MLH1 mutation) is diagnosed with synchronous right-sided colon cancer (caecum) and a polyp at the sigmoid colon that is not amenable to endoscopic resection. What is the most appropriate surgical strategy?
- A Total colectomy with ileorectal anastomosis ✓
- B Right hemicolectomy for the caecal cancer; staged sigmoid resection later
- C Right hemicolectomy with adjuvant chemotherapy and surveillance for sigmoid lesion
- D Extended right hemicolectomy to include the sigmoid polyp site
Explanation
In Lynch syndrome, the lifetime risk of metachronous colorectal cancer is approximately 40–60% after segmental resection, owing to the underlying mismatch repair deficiency causing field cancerisation. For synchronous disease or for Lynch syndrome patients aged <50 with an index cancer, total colectomy with ileorectal anastomosis is recommended to treat both lesions and substantially reduce metachronous colon cancer risk. Segmental resection would leave a highly susceptible remnant colon. Extended right hemicolectomy cannot encompass a sigmoid polyp. This approach is supported by both ESMO and NCCN Lynch syndrome guidelines.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.