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Segmental vs extended colectomy in the management of hereditary nonpolyposis colorectal cancer: a systematic review and meta‐analysis
Author(s) -
Heneghan H. M.,
Martin S. T.,
Winter D. C.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12868
Subject(s) - medicine , colorectal cancer , colectomy , meta analysis , gastroenterology , cancer , oncology , surgery , general surgery
Aim The optimal surgical approach to the management of colorectal cancer in the setting of hereditary nonpolyposis colorectal cancer ( HNPCC ) is contentious. While some advocate total colectomy, others perform segmental resection followed by regular endoscopic surveillance. This systematic review evaluates the evidence for segmental colectomy ( SC ) and total (extended) colectomy ( TC ) in the management of HNPCC . Method Two major databases ( P ub M ed and C ochrane) were searched using predefined terms. All original articles, published in E nglish, comparing the oncological outcomes of SC and TC in HNPCC patients from J anuary 1950 to J uly 2013 were included. Results Eighty‐four studies were identified. After applying exclusion criteria, six studies involving 948 patients were included (mean age 47.4 years, 51.8% male). SC was more commonly performed than TC ( n = 780; 82.3%). Mean follow‐up was 106.5 months. Metachronous high‐risk adenomas were detected more often after SC , although the difference was not statistically significant (23.4% vs 9.6%; OR 2.258, P = 0.057). Metachronous cancers occurred more frequently after SC than after TC (23.5% vs 6.8%; OR 3.679, P < 0.005). However, there was no difference in overall survival (90.7% vs 89.8% for SC and TC , respectively; P = 0.085). Only one study reported operative mortality (0% in each group), there was no report of operative morbidity or functional outcome. Conclusion The optimal surgical approach in the management of HNPCC remains unclear. More adenomas and cancers occur after SC than after TC but there certainly is no evidence to suggest that more radical surgery leads to improved survival.