Total Colectomy with Subtotal Proctocolectomy of High Risk Colorectal Cancer Patients

Abstract = 743 times | PDF = 496 times

Main Article Content

Fadhil Ahmed Mohialdeen


Lynch syndrome is known by an early incidence colorectal cancer and comparatively common synchronous and metachronous neoplastic polyps or cancer or both. The aim of the current study to explore the beneficial of prophylactic colectomy in high risk patients with colorectal cancer. The medical records of 42 colorectal patients whom underwent surgery between 2006 and 2017 of the above hospitals diagnosed as colorectal cancer diseases were retrospectively reviewed. A Structured interview questionnaire was used. The questionnaire was including information on Socio- demographic data such as; age, gender, address, occupation and marital status. In addition, data on the presentation of the disease was obtained and data on complications and post-operative outcomes were also recorded. 42 patients were studied and the mean age ±SD of their age were 49.5± (10.2), 52.4% were male and 47.6% were female.76.1 % of the patients present with a bleeding per-rectum,71.4, 66.6, 61.9 present with abdominal pain, change in bowel habit and abdominal pain respectively. Abdominal mass and rectal mass were 11.9 and 9.5, the most common site of cancer was sigmoid, rectum and caecum 26.19, 14.3 and 11.9 respectively. The post-operative outcome was very less among patients, wound infection, seroma, incisional hernia and chest infection (7%, 7%, 4% and 4% respectively. We concluded from the current study that colorectal cancer with the technique of prophylactic total colectomy with or without subtotal proctectomy that increase the survival, decrease the morbidity and make the endoscopic follow –up easier and more comfortable to the patients for short and long follow-up interval. 


colorectal cancer, total colectomy, subtotal proctectomy.


Download data is not yet available.

Article Details


[1] B. K. Edwards et al., “Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer,” Cancer, vol. 120, no. 9. pp. 1290–1314, 2014.
[2] I. Vogelaar, M. Van Ballegooijen, and D. Schrag…, “How much can current interventions reduce colorectal cancer mortality in the US?,” Cancer, 2006.
[3] H. F. Vasen et al., “Cancer risk in families with hereditary nonpolyposis colorectal cancer diagnosed by mutation analysis.,” Gastroenterology, vol. 110, no. 4, pp. 1020–1027, 1996.
[4] F. M. Giardiello et al., “Guidelines on genetic evaluation and management of lynch syndrome: A consensus statement by the US multi-society task force on colorectal cancer,” Am. J. Gastroenterol., vol. 109, no. 8, pp. 1159–1179, 2014.
[5] E. M. Stoffel et al., “Missed adenomas during colonoscopic surveillance in individuals with Lynch syndrome (hereditary nonpolyposis colorectal cancer),” Cancer Prev. Res., vol. 1, no. 6, pp. 470–475, 2008.
[6] J. Church and C. Simmang, “Practice parameters for the treatment of patients with dominantly inherited colorectal cancer (familial adenomatous polyposis and hereditary nonpolyposis colorectal,” Dis. Colon Rectum, vol. 46, no. 8, pp. 1001–1012, 2003.
[7] A. Umar et al., “Revised Bethesda Guidelines for hereditary nonpolyposis colorectal cancer (Lynch syndrome) and microsatellite instability,” J. Natl. Cancer Inst., vol. 96, no. 4, pp. 261–268, 2004.
[8] M. Aarnio et al., “Cancer risk in mutation carriers of DNA-mismatch-repair genes,” Int. J. Cancer, vol. 81, no. 2, pp. 214–218, 1999.
[9] S. Syngal, J. C. Weeks, D. Schrag, J. E. Garber, and K. M. Kuntz, “Benefits of colonoscopic surveillance and prophylactic colectomy in patients with hereditary nonpolyposis colorectal cancer mutations,” Ann. Intern. Med., vol. 129, no. 10, pp. 787–796, 1998.
[10] G. M. Whitesides, “Whitesides’ Group: Writing a paper,” Adv. Mater., vol. 16, no. 15 SPEC. ISS., pp. 1375–1377, 2004.
[11] H. Vasen, P. Watson, J. Mecklin, and H. Lynch, “New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative Group on HNPCC,” Gastroenterology, vol. 116, no. 6. pp. 1453–1456, 1999.
[12] F. S. Leach et al., “Mutations of a mutS homolog in hereditary nonpolyposis colorectal cancer,” Cell, vol. 75, no. 6, pp. 1215–1225, 1993.
[13] R. Siegel, J. Ma, Z. Zou, and A. Jemal, “Cancer statistics, 2014,” CA Cancer J Clin, vol. 64, no. 1, pp. 9–29, 2014.
[14] H. Hampel et al., “Cancer risk in hereditary nonpolyposis colorectal cancer syndrome: Later age of onset,” Gastroenterology, vol. 129, no. 2, pp. 415–421, 2005.
[15] NCCN, “NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) - Esophageal and Esophagogastric Junction Cancers,” JNCCN J. Natl. Compr. Cancer Netw., 2017.
[16] F Brunicardi. D Andersen. T Billiar. D Dunn. Hunter, “Schwartz’s Principles of Surgery,” in Schwartz’s Principles of Surgery,2010, New-York. McGraw-Hill; 9th ed. 3 (26):1013-1072
[17] Robert DFry, Najjia N. Mahmoud, David J. Joshua I.S, Sabiston textbook of surgery. Colon and rectum .2012.
[18] A.-J. K. A. Rahman Ma ad M., “pattern of colorectal and anal tumor and its surgical treatment,” Baghdad, 2000.
[19] A. N. S. Hassan A. Hassan, “colorectal carcinoma, Presentation and pattern of surgical management at the university hospital,” 2002.
[20] B. G. Al-Bahrani Z, Al-Khateeb A, Degayi O, “Cancer of colon and rectum in Iraq,” Am. J. Proctol. Gastroenterol. Colon Rectal Surg., vol. 31, no. 1, pp. 20–2, 1980.
[21] A. T. O. Waseem, “Colorectal carcinoma presentation and manegment,” 2009.
[22] A. A.-J. Salim Sarraf, “clinical course of colorectal cancer in young patients comparison with old patients,” 1997.
[23] P. K. B. Shyamal K H, “Epidemiological, Clinico-Pathological Profile and Management of Colorectal Carcinoma in a Tertiary Referral Center of Eastern India,” University, JKIMSU.
[24] M. J. Järvinen HJ, Ovaska J, “Improvements in the treatment and prognosis of colorectal carcinoma,” Br. J. Surg., vol. 5, no. 1, pp. 25–7, 1988.
[25] K. J. P. Corman M I, Allison S I, Hand book of colon and rectal surgery. Philadelphia: PA:Lippincott, 2002.
[26] M. J. Järvinen HJ, Aarnio M, Mustonen H, Aktan–Collan K, Aaltonen LA, Peltomäki P, De La Chapelle A, “Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer.,” Gastroenterology, vol. 118, no. 5, pp. 829–34, 2000.
[27] W. H. de Vos tot Nederveen Cappel, “Surveillance for Hereditary Nonpolyposis Colorectal Cancer,” Dis. Colon {&} Rectum, vol. 45, no. 12, pp. 1588–1594, 2002.
[28] S. S. Vasen HF, Abdirahman M, Brohet R, Langers AM, Kleibeuker JH, van Kouwen M, Koornstra JJ, Boot H, Cats A, Dekker E, “One to 2-year surveillance intervals reduce risk of colorectal cancer in families with Lynch syndrome.,” Gastroenterology, vol. 138, no. 7, pp. 2300–6, 2010.
[29] C. J. Kalady MF, McGannon E, Vogel JD, Manilich E, Fazio VW, “Risk of colorectal adenoma and carcinoma after colectomy for colorectal cancer in patients meeting Amsterdam criteria.,” Ann. Surg., vol. 252, no. 3, pp. 507–13, 2010.
[30] K. MF., “Surgical management of hereditary nonpolyposis colorectal cancer.,” Adv. Surg., vol. 45, no. 1, pp. 265–74, 2011.
[31] M. A. Rodríguez-Bigas et al., “Rectal cancer risk in hereditary nonpolyposis colorectal cancer after abdominal colectomy. International Collaborative Group on HNPCC.,” Ann. Surg., vol. 225, no. 2, pp. 202–7, 1997.
[32] L. H. Natarajan N, Watson P, Silva-Lopez E, “Comparison of extended colectomy and limited resection in patients with Lynch syndrome.,” Dis. Colon Rectum, vol. 53, no. 1, pp. 77–82, 2010.
[33] J. M. Parry S, Win AK, Macrae FA, Parry B, Gurrin LC, Lindor NM, Gallinger S, Hopper JL, “Metachronous colorectal cancer risk for mismatch repair gene mutation carriers–the advantage of more extensive surgery.,” Hered. Cancer Clin. Pract., vol. 9, no. S1, p. O1, 2011.
[34] B. G. Costa G, La Torre M, Frezza B, Fransvea P, Tomassini F, Ziparo V, “Changes in the surgical approach to colonic emergencies during a 15-year period.,” Dig. surgery., vol. 31, no. 3, pp. 197–203, 2014.
[35] D. E. Haanstra JF, tot Nederveen WH, Gopie JP, Vecht J, Vanhoutvin SA, Cats A, van der Zaag-Loonen HJ, Langers AM, Bergmann JH, van de Meeberg PC, “Quality of life after surgery for colon cancer in patients with Lynch syndrome: partial versus subtotal colectomy.,” Dis. Colon Rectum., vol. 55, no. 6, pp. 653–9, 2012.
[36] P. S. Beckwith, B. G. Wolff, and R. C. Frazee, “Ileorectostomy in the older patient,” Dis. Colon Rectum, vol. 35, no. 4, pp. 301–304, 1992.
[37] H. J. S. vs. You YN, Chua HK, Nelson H, Hassan I, Barnes SA, “xtended colectomy: measurable differences in morbidity, function, and quality of life.,” Dis. Colon Rectum., vol. 51, no. 7, p. 1036, 2008.
[38] N. H. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart Jr RW, Hellinger M, Flanagan Jr R, Peters W, “Clinical Outcomes of Surgical Therapy Study Group. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial.,” Ann. surgery., vol. 246, no. 4, pp. 655–64, 2007.
[39] C. B. Van Dalen R, Church J, McGannon E, Fay S, Burke C, “Patterns of surgery in patients belonging to amsterdam-positive families.,” Dis. colon rectum., vol. 46, no. 5, pp. 617–20, 2003.
[40] D. R. Möslein G, Nelson H, Thibodeau S, “Rectal carcinomas in HNPCC. InLangenbecks Archiv fur Chirurgie. Supplement. Kongressband.,” Dtsch. Gesellschaft fur Chir. Kongress, vol. 115, pp. 1467–69, 1998.
[41] R.-B. M. Lee JS, Petrelli NJ, “Rectal cancer in hereditary nonpolyposis colorectal cancer.,” Am. J. surgery., vol. 181, no. 3, pp. 207–10, 2001.
[42] C. J. Kalady MF, Lipman J, McGannon E, “Risk of colonic neoplasia after proctectomy for rectal cancer in hereditary nonpolyposis colorectal cancer.,” Ann. surgery., vol. 255, no. 6, pp. 1121–5, 2012.
[43] N. R. Cirillo L, Urso ED, Parrinello G, Pucciarelli S, Moneghini D, Agostini M, Nitti D, “High risk of rectal cancer and of metachronous colorectal cancer in probands of families fulfilling the Amsterdam criteria.,” Ann. surgery., vol. 257, no. 5, pp. 900–4, 2013.
[44] M. ST. Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, “Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients.,” Ann. Surg., vol. 257, no. 4, pp. 679–85, 2013.