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Risk of metachronous colorectal cancer after colectomy for first colon cancer in Lynch syndrome: multicenter retrospective study in Japan

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Abstract

Background

We evaluated the risk of metachronous colorectal cancer (mCRC) and explored the optimal extent of colectomy in patients with Lynch syndrome (LS) and first colon cancer (fCC) in Japan, where the extent of colectomy for colon cancer (CC) is shorter than that in Western countries.

Methods

The clinicopathologic and survival data of patients with LS who developed CC were collected from a nationwide database and analyzed retrospectively. The cumulative incidence of mCRC after actual segmental colectomy was compared with that of mCRC when more extensive colectomy was assumed.

Results

There were 142 eligible patients (65 female). The median age at fCC surgery was 46.5 (range: 14–80) years. The cumulative incidence of 5-, 10-, and 20-year mCRC rate was 13.4%, 20.8%, and 53.6%, respectively. The incidence was higher in the left-sided group (splenic flexure to rectosigmoid colon, n = 54) than in the right-sided group (cecum to transvers colon, n = 88) (66.3% vs. 45.3% in 20 years, P < 0.01). Assuming that all patients would have undergone hemicolectomy or total colectomy, the estimated mCRC risk was 41.5% and 9.4% (P < 0.01, vs. actual procedures), respectively. The 20-year overall survival rate of all the patients was 83.3% without difference by fCC sidedness (P = 0.38).

Conclusions

To reduce the incidence of mCRC, patients with genetically diagnosed LS and fCC, preferentially located in the left-sided colon, may need to undergo more extended colectomy than that usually performed in Japan. However, such extended colectomy should be counterbalanced with favorable overall survival and actual risk of mCRC development.

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Acknowledgements

We thank all study participants and staff for their contributions to this project.

Author information

Authors and Affiliations

  1. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-City, Saitama, 350-8550, Japan

    Kenichi Chikatani, Hideyuki Ishida & Yoshiko Mori

  2. The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan

    Hideyuki Ishida, 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

  3. Department of Clinical Genetics, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Takeshi Nakajima & Arisa Ueki

  4. Department of Molecular Diagnosis and Cancer Prevention, Saitama Cancer Center, Saitama, Japan

    Kiwamu Akagi

  5. Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Akinari Takao

  6. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Masayoshi Yamada

  7. Department of Surgery, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan

    Fumitaka Taniguchi & Kohji Tanakaya

  8. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan

    Koji Komori

  9. Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan

    Kazuhito Sasaki

  10. Department of Surgery, Kurume University, Fukuoka, Japan

    Tomoya Sudo

  11. Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    Yasuyuki Miyakura

  12. Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Akiko Chino

  13. Department of Clinical Genetics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Tatsuro Yamaguchi

  14. Cancer Treatment Center, Toyonaka Municipal Hospital, Osaka, Japan

    Naohiro Tomita

  15. Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan

    Yoichi Ajioka

  16. Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

    Yoichi Ajioka

Authors
  1. Kenichi Chikatani
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  2. Hideyuki Ishida
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  3. Yoshiko Mori
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  8. Masayoshi Yamada
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  18. Yoichi Ajioka
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Contributions

All authors contributed to the study’s conception and design. KC, YM, HI, TY, NT, and KT developed the main concept and designed the study. KC wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kenichi Chikatani.

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The authors declare that they have no conflicts of interest.

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Takeshi Nakajima: Affiliation has been moved to Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan.

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Chikatani, K., Ishida, H., Mori, Y. et al. Risk of metachronous colorectal cancer after colectomy for first colon cancer in Lynch syndrome: multicenter retrospective study in Japan. Int J Clin Oncol 28, 1633–1640 (2023). https://doi.org/10.1007/s10147-023-02412-z

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