On Hereditary Colorectal Cancer: What Is the Appropriate Surgical Technique?

Abstract

Explore the pathogenesis, unique features, and various prophylactic as well as therapeutic surgical techniques used in the two most common types of hereditary colorectal cancer Lynch syndrome (LS) and familial adenomatous polyposis (FAP). In LS patients, it is important to determine the genetic risk panel before undergoing surgery. In practice, 22% of surgeons prefer to perform a subtotal colectomy at diagnosis of LS, and more than a half recommend a subtotal colectomy at diagnosis of CRC. In FAP patients, most surgeons would choose proctocolectomy + ileal pouch-anal anastomosis (IPAA) rather than total colectomy + ileorectal anastomosis (IRA), as the remaining rectum might harbor disease and will require surveillance. The role of laparoscopy and robotics has been introduced in the management of these operations over the past few years. Different surgical techniques are used as prophylactic or therapeutic measures in patients with LS and FAP. The main question is to determine how extensive the surgery should be, rather than deciding on the need or on the timing of intervention. Regardless of the surgical technique options, all decisions need to be individualized and best undertaken with the patient, patient’s family, and a multi-disciplinary team.