A 55-year-old patient with Lynch syndrome (MLH1 germline mutation) has had a right hemicolectomy for a Dukes B colon cancer. Surveillance colonoscopy reveals a 1 cm polyp in the sigmoid colon with high-grade dysplasia. What is the recommended management?

• A Polypectomy and annual surveillance colonoscopy
• B Completion subtotal colectomy with ileorectal anastomosis ✓
• C Segmental sigmoidectomy only
• D Chemoprevention with aspirin and 3-yearly colonoscopy

Explanation

Lynch syndrome patients with MLH1/MSH2 mutations have a 40–80% lifetime risk of colorectal cancer and often develop synchronous or metachronous cancers throughout the colon. When an advanced neoplasm (high-grade dysplasia or cancer) is found in the residual colon after a prior resection, completion subtotal colectomy with ileorectal anastomosis is recommended to eliminate field risk. Segmental resection leaves the at-risk colon in situ, and polypectomy alone is insufficient for high-grade lesions in this hereditary context.

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

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Written and medically reviewed by the StethoPrep medical team.