V. N. Kozak, M. F. Kalady, M. M. Gamaleldin, J. Liang, J. M. Church

Although sporadic colorectal cancer (CRC) usually occurs in patients over 50, recent evidence suggests that the incidence is increasing in younger patients. Such patients are theoretically at high risk of metachronous neoplasia and may be candidates for extended, prophylactic, colectomy. This study aimed to define the risk of metachronous cancer/adenomas during follow-up of younger patients who underwent segmental colectomy for CRC. A CRC database was used to identify patients aged less than 50 who underwent surgery for CRC between 1994 and 2010.. Patients diagnosed with hereditary cancer or inflammatory bowel disease were excluded. The primary endpoints were frequency of extended resections, and the rates of metachronous cancer and high-risk adenomas during follow-up. There were 284 young patients with a resectable primary tumor, of which 280 (98.6%) underwent segmental resection, 3 (1%) extended and 1 (0.4%) local. Endoscopic follow-up was available for 150 of the patients who had segmental colectomy, with mean age 42.6 years (±5.8) at diagnosis and median follow-up time of 68 months (IQR, 45-105). Out of these 150 patients, 4 (2.7%) developed metachronous colonic adenocarcinoma at 24, 71, 151 and 228 months after index surgery. Thirty additional patients had at least one adenoma identified during surveillance, and 3 had sessile serrated polyps. Out of the 3 patients undergoing extended resection, none had metachronous cancer or advanced adenomas at an average follow up of 17 years. A segmental colectomy or proctectomy is adequate treatment for patients presenting with colorectal cancer under age 50. . This article is protected by copyright. All rights reserved.