A patient with Lynch syndrome (HNPCC) is diagnosed with colon cancer at age 42. What is the recommended surgical approach compared to sporadic colon cancer?

• A Segmental colectomy same as sporadic cancer
• B Proctocolectomy with ileostomy as prophylaxis
• C Surveillance colonoscopy alone without surgery
• D Subtotal or total colectomy with ileorectal anastomosis due to high metachronous cancer risk ✓

Explanation

Lynch syndrome carries a 40-70% lifetime risk of colorectal cancer, with a significant risk of metachronous colon cancer (10-year risk approximately 25-45% after segmental resection). Therefore, subtotal or total colectomy with ileorectal anastomosis is preferred over segmental resection for young Lynch syndrome patients, particularly when the rectum is not involved, as this dramatically reduces the risk of metachronous cancer while maintaining intestinal continuity. The decision must be individualized based on age, rectum involvement, patient preference, and germline mutation type (MLH1/MSH2 carry higher risk than MSH6/PMS2).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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