Surgical Strategies for Management of the Lynch Syndromes

The most important consideration in the treatment of patients with the Lynch Syndromes is recognition. Specific treatment recommendations are based on the natural history of the syndrome. The newly diagnosed colon cancer patient from a Lynch Syndrome family should undergo a subtotal colectomy with low ileorectal anastomosis because of the frequency of synchronous and metachronous colon cancers. Routine sacrifice of the rectum is not justified because of the propensity for the cancers to involve the proximal colon. Lynch Syndrome II patients must have additional recommendations made to address the integrally inherited extracolonic cancer, i. e., total abdominal history and bilateral salpingo-oophorectomy (TAHBSO). For patients who are as yet unaffected by cancer, prophylactic surgery is not felt to be justified because only 50% of first degree relatives of Lynch Syndrome patients are at risk. Finally, for a patient who has been treated for colon cancer before being recognized as a member of a Lynch Syndrome family our current recommendation is aggressive screening. Subtotal colectomy is reserved for the poorly compliant patient.