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Limited resection in CRC puts young patients at risk for recurrence
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HONOLULU — Due to a lack of accessible testing results, many patients at risk of Lynch syndrome do not undergo total or subtotal colectomy at first surgical encounter, putting them at risk for a recurrence of colorectal cancer, according to a poster presented at ACG 2015.
“Young patients can be at risk for a number of conditions that would put them at risk for a second colon cancer. Lynch syndrome, familial adenomatous polyposis and inflammatory bowel disease could all put you at risk for a second cancer,” Jordan J. Karlitz, MD, assistant professor of medicine, Tulane University School of Medicine, New Orleans, told Healio Gastroenterology.
Karlitz and colleagues used population-based statewide data from the Louisiana Tumor Registry, which is part of the Surveillance, Epidemiology, and End Results program, to determine if young CRC patients are receiving total or subtotal colectomies or if they are receiving segmental resections and what factors lead to that decision.
Of 2,427 CRC patients, 274 were aged younger than 50 years, according to the abstract. Of those, 234 underwent surgery at 53 unique facilities.
“The overall subtotal/total colectomy rate was fairly low at 6.8% and very obvious things like large numbers of adenomas, having IBD or having multiple synchronous or metachronous cancers … were associated with total or subtotal colectomy,” Karlitz said. “But patients that had abnormal tumor testing, including microsatellite instability or immunohistochemistry testing raising concern for Lynch syndrome, were not undergoing colectomy. That’s probably because the timing of the testing. The test results were not necessarily available at the time of surgery. Ideally, these tumor test results can help stratify patients for germline genetic testing to confirm Lynch syndrome preoperatively and guide surgical management”
Colectomy predictors included age younger than 45 years, polyposis (>10 adenomas; P < .0001), synchronous/metachronous Lynch syndrome-associated cancer (P < .0001) and IBD (P < .0241). According to the abstract, at least 25% of patients, based on historical hereditary CRC and IBD estimates in young patients, would benefit from total/subtotal colectomy .
Karlitz and colleagues previously showed that microsatellite instability testing was low at 23% and those testing results were only available preoperatively in 16.9% of the 2011 cohort.
“We’re hoping this will raise awareness of the importance of getting test results before surgery,” Karlitz said. “Hopefully, further studies will be conducted to look into the preoperative process in detail to discover the factors involved so we can streamline test result availability. It will also be important to look at provider and patient preference with regard to colonic resection extent as this may influence operative decisions independent of the aforementioned factors” – by Katrina Altersitz
Reference:
Karlitz JJ. Abstract P1567. Presented at: ACG; Oct. 16-21, 2015; Honolulu.
Disclosures: Karlitz reports no relevant financial disclosures.