On Hereditary Colorectal Cancer: What Is the Appropriate Surgical Technique?
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SURGERY AND SURGICAL INNOVATIONS IN COLORECTAL CANCER (S HUERTA, SECTION EDITOR)
On Hereditary Colorectal Cancer: What Is the Appropriate Surgical Technique? Hector M. Ibarvo Gracia 1 & Iris G. Saldaña Sanchez 2 & Abdul Kader Natour 3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review 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). Recent Findings 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. Summary 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. Keywords Hereditary colorectal cancer . Surgical technique . Familial adenomatous polyposis . Lynch syndrome . Total colectomy . Proctocolectomy
Topical Collection on Surgery and Surgical Innovations in Colorectal Cancer * Hector M. Ibarvo Gracia [email protected] Iris G. Saldaña Sanchez [email protected] Abdul Kader Natour [email protected] 1
Department of Laparoscopic Pediatric Surgery, Hospital Infantil de México Federico Gómez, Calle Dr. Márquez No. 162, Cuahtémoc, Doctores, 06720 Ciudad de México, Mexico
2
Department of Pediatric Surgery, Hospital de pediatría Centro médico Nacional Siglo XXI, Dr. Ignacio Morones Prieto 605, Buenos Aires, Cuauhtémoc, 06720 Ciudad De México, CDMX, Mexico
3
American University of Beirut, Bliss Street, Beirut, Lebanon
Introduction Hereditary colorectal cancer (HCC) is responsible for 5% of all colorectal cancer cases. Its early onset, its synchronous/ metachronous occurrences, and its association with other cancers are some of its unique features that allow early suspicion of the disease [1••]. However, occasionally, the non-specific clinical manifestations make its diagnosis challenging. Genetic predisposition plays a major role in the pathogenesis of HCC, as well as in determining the clinical course and prognosis of the disease, especially in the young population (< 30 years) [2]. Lynch syndrome (LS), familial adenomatous polyposis (FAP), MUTYH-associated poly
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