Segmental versus extended resection for sporadic colorectal cancer in young patients

Abstract

Extended colectomy for sporadic CRC in patients younger than 50 does not improve disease-free or overall survival. Further study to determine if segmental resection is appropriate oncologic treatment is warranted.

Colorectal surveillance after segmental resection for young‐onset colorectal cancer: is there evidence for extended resection?

“…The results of this retrospective audit confirm that that performing an extended resection for young patients with apparently sporadic CRC is not common practice, and this concurs with the published literature on the topic . Whilst it could be argued that an extended resection might protect against future neoplasia, our findings show that, after excluding patients with hereditary CRC or inflammatory bowel disease, rates of metachronous cancer in patients younger than 50 undergoing segmental resection were no higher than expected for the general population.…”

“…National Comprehensive Cancer Network (NCCN) guidelines state ‘consider more extensive colectomy for patients with a strong family history of colon cancer or young age (< 50 years)’. We could find only one study in the literature comparing survival between young patients with sporadic CRC undergoing segmental vs extended colectomy . Although metachronous lesions in their cohort were only found in patients who underwent segmental colectomy, it was not translated into any improvement in disease‐free or overall survival with extended colectomy.…”

Colorectal cancer in young adults: A difficult challenge

“…Eventually, young age may affect therapeutic decisions, as patients with sporadic cancers before 50 years have been considered for a subtotal colectomy, although this decision not always translates into a greater survival[ 31 ]. Otherwise, the recognition of a hereditary syndrome would certainly support the indication of a total colectomy and suggest familial surveillance, besides the absence of prospective randomized trials comparing extended and segmental resections[ 32 ].…”

Factors Associated With the Performance of Extended Colonic Resection vs. Segmental Resection in Early-Onset Colorectal Cancer: A Population-Based Study

“…However, according to the National Comprehensive Cancer Network (NCCN), more extensive colectomy can be generally considered in young patients, age <50 years. 5 , 6 The latter subgroup is primarily composed of known hereditary disorders (Lynch syndrome (LS), familial adenomatous polyposis (FAP)) and inflammatory bowel disease (IBD; ulcerative colitis, Crohn's disease). In hereditary disorders and IBD, segmental resection, in contrast to ECR (subtotal/total/proctocolectomy), is associated with increased metachronous CRC risk.…”

“… 19 LS testing includes tumor analysis for microsatellite instability (MSI) and/or immunohistochemistry (IHC) staining for mismatch repair proteins to stratify for germline genetic testing. 6 , 10 , 20 , 21 Ideally, tumor analysis results should be available preoperatively to facilitate surgical planning. 10 Mutations in four mismatch repair genes ( MLH1 , MSH2 , MSH6 , and PMS2 ) and epithelial cell adhesion molecule are most common.…”