Kwaliteit van leven bij patiënten met het Lynch syndroom na colectomie : Partiële versus (sub)totale colectomie

Lynch syndrome is an autosomal dominant disorder and is characterized by a life-time risk to develop colorectal carcinoma (CRC) of approximately 80%. Mutation carriers are advised to participate in intensive colonoscopic surveillance programs. The aim of these programs is to detect and remove adenomatous polyps, the premalignant lesions of CRC. If CRC is detected while under surveillance in a patient under the age of 60 years a subtotal colectomy is advised because of the high risk of a metachronous CRC after partial colectomy. Subtotal colectomy reduces this risk and subsequently leads to a higher life expectancy. When CRC is detected above the age of 60, partial colectomy is probably justified because of the lower risk of developing metachronous neoplasia during the remaining life. Moreover, in a patient over 60 years a subtotal colectomy more often causes fecal incontinence. To date there are no studies that examined the quality of life (QoL) and functional outcome after both types of surgery in patients with the Lynch syndrome. The question whether QoL differs between partial and subtotal colectomy is becoming more important because of diminishing risks to develop CRC under surveillance. If there is a substantial difference in QoL between both procedures the advice to perform a subtotal colectomy might be revised. The purpose of this study was to investigate QoL after partial colectomy and subtotal colectomy in patients with the Lynch syndrome. Methods Two questionnaires about QoL (SF-36 and EORTC QLQ CR-38) and a questionnaire about functional outcome (COREFO) were send to 168 operated patients with the Lynch syndrome. Surveillance reports were reviewed on development of metachronous CRC. Results The response rate was 70,24%. None of the scales of the SF-36 showed a significant difference between both groups. The EORTC QLQ CR-38 presented more problems with defecation after subtotal colectomy (p=0,012). Analysis of the COREFO revealed that after subtotal colectomy patients have a significant higher frequency of defecation compared to patients who underwent a partial colectomy. The 10 years cumulative risk of developing a metachronous CRC was 12,8% after partial colectomy compared to 0% after subtotal colectomy. Conclusions Although the stool frequency is higher after subtotal colectomy compared to partial colectomy, QoL does not differ between both types of surgery in patients with the Lynch syndrome. The risk of developing metachronous CRC after surgery is substantially lower after a subtotal colectomy. Therefore, for young patients that develop a CRC under surveillance a subtotal colectomy should be recommended. Patients need to be informed about possible differences in functional outcome.