Publication

Decision analysis in the surgical treatment of colorectal cancer due to a mismatch repair gene defect

Cappel, WHDTN., Buskens, E., van Duijvendijk, P., Cats, A., Menko, FH., Griffioen, G., Slors, JF., Nagengast, FM., Kleibeuker, JH. & Vasen, HFA., 1-Dec-2003, In : Gut. 52, 12, p. 1752-1755 4 p.

Research output: Contribution to journalArticleAcademicpeer-review

Background: In view of the high risk of developing a new primary colorectal carcinoma (CRC), subtotal colectomy rather than segmental resection or hemicolectomy is the preferred treatment in hereditary nonpolyposis colorectal cancer (HNPCC) patients. Subtotal colectomy however implies a substantial decrease in quality of life. To date, colonoscopic surveillance has been shown to reduce CRC occurrence.

Aims: To compare the potential health effects in terms of life expectancy ( LE) for patients undergoing subtotal colectomy or hemicolectomy for CRC.

Methods: A decision analysis ( Markov) model was created. Information on the 10 year risk of CRC after subtotal colectomy (4%) and hemicolectomy (16%) and stages of CRCs detected within a two year surveillance interval (32% Dukes' A, 54% Dukes' B, and 14% Dukes' C) were derived from two cohort studies. Five year survival rates used for the different Dukes stages ( A, B, and C) were 98%, 80%, and 60%, respectively. Remaining LE values were calculated for hypothetical cohorts with an age at CRC diagnosis of 27, 47, and 67 years, respectively. Remaining LE values were also calculated for patients with CRC of Dukes' stage A.

Results: The overall LE gain of subtotal colectomy compared with hemicolectomy at ages 27, 47, and 67 was 2.3, 1, and 0.3 years, respectively. Specifically for Dukes' stage A, this would be 3.4, 1.5, and 0.4 years.

Conclusions: Unless surveillance results improve, subtotal colectomy still seems the preferred treatment for CRC in HNPCC in view of the difference in LE. For older patients, hemicolectomy may be an option as there is no appreciable difference in LE.

Original languageEnglish
Pages (from-to)1752-1755
Number of pages4
JournalGut
Volume52
Issue number12
Publication statusPublished - 1-Dec-2003
EventDigestive Disease Week Meeting/103rd Annual Meeting of the American-Gastroenterology-Association -
Duration: 19-May-200223-May-2002

Event

Digestive Disease Week Meeting/103rd Annual Meeting of the American-Gastroenterology-Association

19/05/200223/05/2002

Event: Other

    Keywords

  • FAMILIAL ADENOMATOUS POLYPOSIS, ILEORECTAL ANASTOMOSIS, MUTATION CARRIERS, COLECTOMY, CARCINOMA, RISK, SURVIVAL, TRIAL, PROCTOCOLECTOMY, SURVEILLANCE

ID: 4148042