Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/87790
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Type: Journal article
Title: Risk of metachronous colon cancer following surgery for rectal cancer in mismatch repair gene mutation carriers
Author: Win, A.
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.
Citation: Annals of Surgical Oncology, 2013; 20(6):1829-1836
Publisher: Lippincott, Williams & Wilkins
Issue Date: 2013
ISSN: 1068-9265
1534-4681
Statement of
Responsibility: 
Aung Ko Win, Susan Parry, Bryan Parry, Matthew F. Kalady, Finlay A. Macrae, Dennis J. Ahnen, Graeme P. Young, Lara Lipton, Ingrid Winship, Alex Boussioutas, Joanne P. Young, Daniel D. Buchanan, Julie Arnold, Loïc Le Marchand, Polly A. Newcomb, Robert W. Haile, Noralane M. Lindor, Steven Gallinger, John L. Hopper and Mark A. Jenkins
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.
Keywords: No keywords specified
Rights: © Society of Surgical Oncology 2013
RMID: 0030012017
DOI: 10.1245/s10434-012-2858-5
Appears in Collections:Medicine publications

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