Risk of metachronous colorectal cancer after surgical resection of index rectal cancer in Lynch syndrome: a multicenter retrospective study in Japan

Kenichi Chikatani; Hideyuki Ishida; Yoshiko Mori; Takeshi Nakajima; Arisa Ueki; Kiwamu Akagi; Akinari Takao; Masayoshi Yamada; Fumitaka Taniguchi; Koji Komori; Kazuhito Sasaki; Tomoya Sudo; Yasuyuki Miyakura; Akiko Chino; Tatsuro Yamaguchi; Kohji Tanakaya; Naohiro Tomita; Yoichi Ajioka

doi:10.1007/s00595-024-02815-z

Risk of metachronous colorectal cancer after surgical resection of index rectal cancer in Lynch syndrome: a multicenter retrospective study in Japan

Surg Today. 2024 Mar 19. doi: 10.1007/s00595-024-02815-z. Online ahead of print.

Authors

Kenichi Chikatani¹, Hideyuki Ishida^{2

3}, Yoshiko Mori², Takeshi Nakajima^{3

4

5}, Arisa Ueki⁴, Kiwamu Akagi^{3

6}, Akinari Takao^{3

7}, Masayoshi Yamada^{3

8}, Fumitaka Taniguchi⁹, Koji Komori^{3

10}, Kazuhito Sasaki^{3

11}, Tomoya Sudo^{3

12}, Yasuyuki Miyakura^{3

13}, Akiko Chino^{3

14}, Tatsuro Yamaguchi^{3

15}, Kohji Tanakaya^{3

9}, Naohiro Tomita^{3

16}, Yoichi Ajioka^{17

18}

Affiliations

¹ Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan. chikatan@saitama-med.ac.jp.
² Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
³ The Committee of Hereditary Colorectal Cancer in the Japanese Society for Cancer of the Colon and Rectum (JSCCR), Tokyo, Japan.
⁴ Department of Clinical Genetics, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
⁵ Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan.
⁶ Department of Molecular Diagnosis and Cancer Prevention, Saitama Cancer Center, Saitama, Japan.
⁷ Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁸ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
⁹ Department of Surgery, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan.
¹⁰ Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan.
¹¹ Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
¹² Department of Surgery, Kurume University, Fukuoka, Japan.
¹³ Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
¹⁴ Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁵ Department of Clinical Genetics, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
¹⁶ Cancer Treatment Center, Toyonaka Municipal Hospital, Osaka, Japan.
¹⁷ Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.
¹⁸ Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.

PMID: 38502210
DOI: 10.1007/s00595-024-02815-z

Abstract

Purpose: This study evaluated the risk of metachronous colorectal cancer (CRC) after resection of index (first) rectal cancer in patients with Lynch syndrome (LS).

Methods: Clinicopathological data of patients with genetically proven LS were retrospectively analyzed in this multicenter Japanese study. The cumulative incidence of metachronous CRC and the overall survival were compared between patients with index rectal cancer (rectal group) and those with index colon cancer (colon group).

Results: The median age at index CRC surgery was lower in the rectal group than in the colon group (37 vs. 46 years old, P = 0.01). The cumulative 5-, 10-, and 20-year incidences of metachronous CRC were 3.5%, 13.9%, and 21.1%, respectively, in the rectal cancer group and 14.9%, 22.0%, and 57.9%, respectively, in the colon cancer group (P = 0.02). The overall survival curves were not significantly different between two groups (P = 0.23).

Conclusion: This is the first report from an East Asian country to report the risk of metachronous CRC after resection of index rectal cancer in patients with LS. Despite this study having several limitations, we cannot recommend extended resection, such as total proctocolectomy, for index rectal cancer as a standard surgical treatment in patients with LS.

Keywords: Colorectal cancer; Lynch syndrome; Metachronous colorectal cancer; Rectal cancer.