A 58-year-old woman with Lynch syndrome (MLH1 mutation) is diagnosed with right-sided colon cancer (cT3N0M0). After counselling, she opts for colectomy. What extent of resection is recommended in Lynch syndrome patients?
- A Standard segmental colectomy with 5 cm margins
- B Subtotal colectomy with ileorectal anastomosis ✓
- C Extended right hemicolectomy to the splenic flexure
- D Total proctocolectomy with ileoanal pouch
Correct answer: B. Subtotal colectomy with ileorectal anastomosis
Explanation
Lynch syndrome patients have a 45-70% lifetime risk of colorectal cancer and a significant risk of metachronous colorectal cancers. Subtotal colectomy with ileorectal anastomosis is recommended as it removes the high-risk colon while avoiding a permanent stoma and is preferred over segmental resection in fit patients. Total proctocolectomy is reserved for patients with rectal involvement or when an ileorectal anastomosis is not feasible.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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