Current Surgical Concepts in Lynch Syndrome and Familial Adenomatous Polyposis.

IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Visceral Medicine Pub Date : 2023-03-01 Epub Date: 2023-03-28 DOI:10.1159/000530030
Karoline Horisberger, Carolina Mann, Hauke Lang
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Abstract

Background: Approximately 5% of colorectal cancers (CRCs) are associated with hereditary cancer syndromes. The natural history of these syndromes differs from sporadic cancers, and due to their increased risk of metachronous carcinomas, surgical approaches also differ. This review focuses on the current recommendations for surgical treatment and what evidence has led to these recommendations in the most clinically relevant hereditary CRC syndromes: Lynch syndrome (LS) and (attenuated) familial adenomatous polyposis (FAP).

Summary: LS has no common phenotype and is caused by individual germline variants in one of the mismatch repair genes (MLH1, MSH2, MSH6, or PMS2). Because each gene is associated with a different risk of metachronous cancer, guidelines now differentiate between genes in their recommendations for oncology interventions. Classical and attenuated FAP are caused by germline mutations in the APC gene and have a characteristic phenotype. Although correlations exist between phenotype and genotype, the indication for surgery is predominantly based on clinical manifestation rather than specific gene mutations.

Key message: Currently, the recommendation on the two diseases tends to go in opposite directions: while some forms of FAP may require less extensive surgery, in some LS patients, more sophisticated knowledge of metachronous carcinoma risk leads to more extensive surgery.

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林奇综合征和家族性腺瘤性息肉病的当前手术概念。
背景:约有 5% 的结直肠癌 (CRC) 与遗传性癌症综合征有关。这些综合征的自然病史与散发性癌症不同,而且由于其发生间变性癌的风险增加,手术方法也有所不同。本综述重点介绍目前对遗传性 CRC 综合征手术治疗的建议,以及导致这些建议的证据:摘要:林奇综合征没有共同的表型,是由错配修复基因(MLH1、MSH2、MSH6 或 PMS2)之一的单个种系变异引起的。由于每种基因都与不同的罹患晚期癌症的风险有关,因此现在的指南在推荐肿瘤学干预措施时会区分不同的基因。典型和减弱的 FAP 是由 APC 基因的种系突变引起的,具有特征性的表型。虽然表型与基因型之间存在相关性,但手术指征主要基于临床表现而非特定基因突变:目前,对这两种疾病的建议倾向于相反的方向:虽然某些形式的 FAP 可能需要较小范围的手术,但对某些 LS 患者来说,对远期癌风险的更深入了解会导致更大范围的手术。
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来源期刊
Visceral Medicine
Visceral Medicine Medicine-Surgery
CiteScore
4.50
自引率
0.00%
发文量
40
期刊介绍: This interdisciplinary journal is unique in its field as it covers the principles of both gastrointestinal medicine and surgery required for treating abdominal diseases. In each issue invited reviews provide a comprehensive overview of one selected topic. Thus, a sound background of the state of the art in clinical practice and research is provided. A panel of specialists in gastroenterology, surgery, radiology, and pathology discusses different approaches to diagnosis and treatment of the topic covered in the respective issue. Original articles, case reports, and commentaries make for further interesting reading.
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