title: Quality of life after surgery for colon cancer in patients with Lynch syndrome: partial versus subtotal colectomy.
abstract: BACKGROUND
  Lynch syndrome is a disorder caused by mismatch repair gene mutations. Mutation carriers have a high risk of developing colorectal cancer. In patients with Lynch syndrome in whom colon cancer has been diagnosed, in general, subtotal colectomy instead of partial colectomy is recommended because of the substantial risk of metachronous colorectal cancer. However, the effect of more extensive surgery on quality of life and functional outcome is unknown.
  
  
  OBJECTIVE
  The aim of this study was to investigate quality of life and functional outcome in patients with Lynch syndrome after partial colectomy and subtotal colectomy.
  
  
  METHODS
  This is a nationwide cross-sectional study in the Netherlands.
  
  
  METHODS
  Two quality-of-life questionnaires (Short Form-36 and The European Organization for Research and Treatment of Cancer Colorectal Cancer-specific Quality of Life Questionnaire Module) and a functional outcome questionnaire (Colorectal Functional Outcome) were used.
  
  
  METHODS
  Patients with Lynch syndrome who underwent surgery for colon cancer were included.
  
  
  METHODS
  The primary outcomes measured were quality of life and functional outcome.
  
  
  RESULTS
  Questionnaires were sent to 192 patients with Lynch syndrome who underwent surgery for colorectal cancer. A total of 136 patients returned the questionnaire (response rate, 71%). Eighteen patients with rectal cancer, 9 patients with a permanent ileostomy, and 5 patients with an IPAA were excluded. Fifty-one patients underwent partial colectomy, and 53 underwent subtotal colectomy. None of the scales of the Short Form-36 survey showed a significant difference. Analysis of the Colorectal Functional Outcome questionnaire revealed that, after subtotal colectomy, patients have a significantly higher stool frequency (p ≤ 0.01) and a significantly higher score on stool-related aspects (p = 0.06) and social impact (p = 0.03). The European Organization for Research and Treatment of Cancer Colorectal Cancer-specific Quality of Life Questionnaire Module presented more problems with defecation after subtotal colectomy (p ≤ 0.01).
  
  
  CONCLUSIONS
  Certain selection bias cannot be ruled out.
  
  
  CONCLUSIONS
  Although functional outcome is worse after subtotal colectomy than after partial colectomy, generic quality of life does not differ after the 2 types of surgery in Lynch syndrome. When discussing the options for surgery with the patient, all advantages and disadvantages of both surgical procedures, including quality of life and functional outcome, should be discussed.
authors.affiliation: Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands. jf.haanstra@umcg.nl
authors.forename: Jasmijn F
authors.initials: JF
authors.lastname: Haanstra
authors.forename: Wouter H
authors.initials: WH
authors.lastname: de Vos Tot Nederveen Cappel
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Gopie
authors.forename: Juda
authors.initials: J
authors.lastname: Vecht
authors.forename: Steven A L W
authors.initials: SA
authors.lastname: Vanhoutvin
authors.forename: Annemieke
authors.initials: A
authors.lastname: Cats
authors.forename: Hester J
authors.initials: HJ
authors.lastname: van der Zaag-Loonen
authors.forename: Alexandra M J
authors.initials: AM
authors.lastname: Langers
authors.forename: Jerry H W
authors.initials: JH
authors.lastname: Bergmann
authors.forename: Paul C
authors.initials: PC
authors.lastname: van de Meeberg
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.forename: Jan H
authors.initials: JH
authors.lastname: Kleibeuker
authors.forename: Hans F A
authors.initials: HF
authors.lastname: Vasen
authors.forename: Fokko M
authors.initials: FM
authors.lastname: Nagengast
authors.forename: Peter
authors.initials: P
authors.lastname: van Duijvendijk
mesh_terms: D016009:Chi-Square Distribution; D003082:Colectomy / Q000379:methods*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000235:genetics / Q000503:physiopathology / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011788:Quality of Life; D020127:Recovery of Function; D012042:Registries; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome