Risk of metachronous colon cancer following surgery for rectal cancer in mismatch repair gene mutation carriers

Aung Ko Win, Susan Parry, Bryan Parry, Matthew Kalady, Finlay Macrae, Dennis Ahnen, Graeme Young, Lara Lipton, Ingrid Winship, Alex Boussioutas, Joanne Young, Daniel Buchanan, Julie Arnold, Loic Le Marchand, Polly Newcomb, Robert Haile, Noralene Lindor, Steven Gallinger, John Hopper, Mark Jenkins

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    69 Citations (Scopus)

    Abstract

    Background: Despite regular surveillance colonoscopy, the metachronous colorectal cancer risk for mismatch repair (MMR) gene mutation carriers after segmental resection for colon cancer is high and total or subtotal colectomy is the preferred option. However, if the index cancer is in the rectum, management decisions are complicated by considerations of impaired bowel function. We aimed to estimate the risk of metachronous colon cancer for MMR gene mutation carriers who underwent a proctectomy for index rectal cancer. Methods: This retrospective cohort study comprised 79 carriers of germline mutation in a MMR gene (18 MLH1, 55 MSH2, 4 MSH6, and 2 PMS2) from the Colon Cancer Family Registry who had had a proctectomy for index rectal cancer. Cumulative risks of metachronous colon cancer were calculated using the Kaplan-Meier method. Results: During median 9 years (range 1-32 years) of observation since the first diagnosis of rectal cancer, 21 carriers (27 %) were diagnosed with metachronous colon cancer (incidence 24.25, 95 % confidence interval [CI] 15.81-37.19 per 1,000 person-years). Cumulative risk of metachronous colon cancer was 19 % (95 % CI 9-31 %) at 10 years, 47 (95 % CI 31-68 %) at 20 years, and 69 % (95 % CI 45-89 %) at 30 years after surgical resection. The frequency of surveillance colonoscopy was 1 colonoscopy per 1.16 years (95 % CI 1.01-1.31 years). The AJCC stages of the metachronous cancers, where available, were 72 % stage I, 22 % stage II, and 6 % stage III. Conclusions: Given the high metachronous colon cancer risk for MMR gene mutation carriers diagnosed with an index rectal cancer, proctocolectomy may need to be considered.

    Original languageEnglish
    Pages (from-to)1829-1836
    Number of pages8
    JournalAnnals of Surgical Oncology
    Volume20
    Issue number6
    DOIs
    Publication statusPublished - 2013

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  • Cite this

    Win, A. K., Parry, S., Parry, B., Kalady, M., Macrae, F., Ahnen, D., Young, G., Lipton, L., Winship, I., Boussioutas, A., Young, J., Buchanan, D., Arnold, J., Le Marchand, L., Newcomb, P., Haile, R., Lindor, N., Gallinger, S., Hopper, J., & Jenkins, M. (2013). Risk of metachronous colon cancer following surgery for rectal cancer in mismatch repair gene mutation carriers. Annals of Surgical Oncology, 20(6), 1829-1836. https://doi.org/10.1245/s10434-012-2858-5