A bi-national perspective on the management of young patients with colorectal cancer.
BACKGROUND
Young patients with colorectal cancer pose diagnostic and management challenges. The study aim was to assess colorectal surgical practice in Australia and New Zealand with respect to management of young patients with colorectal cancer and the impact of family history.


METHODS
An electronic survey was sent to members of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). The survey assessed the clinical practice of the respondent and utilized scenario-based questions to investigate their clinical approach to patients under 50 years who develop colorectal cancer with respect to management and surveillance. Colorectal society trainees, members and fellows were also questioned on a scenario of polyposis and no vertical transmission, and which operation they would perform.


RESULTS
Of the 189 surveys sent out, 114 respondents completed the survey (60.3%) with 99 (86.8%) respondents practicing colorectal surgeons and 13.2% (15) CSSANZ trainees. Ninety-five percent of respondents had a practice with greater than 70% colorectal work. Of the surgeons and trainees, 92.1% (105) would perform a limited resection in a young patient with a right-sided cancer. Six percent altered the approach if there was a first-degree relative with colorectal cancer, and 68% altered the approach if the family history fulfilled criteria for hereditary non-polyposis colorectal cancer. Only 22.8% of respondents could recognize potential MutYH-associated polyposis with moderate polyposis and absence of vertical transmission.


CONCLUSIONS
Colorectal surgeons in Australia will modify their management of patients under 50 years with colorectal cancer based on a family history and risk of inherited colorectal cancer syndromes. Further education could improve management.
Department of Surgery, Epworth Healthcare, Melbourne, Victoria, Australia.
Satish K
SK
Warrier
A Craig
AC
Lynch
Alexander G
AG
Heriot
D011125:Adenomatous Polyposis Coli / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D001315:Australia; D002983:Clinical Competence; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods* / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009520:New Zealand; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018570:Risk Assessment
HNPCC; colorectal cancer; colorectal surgery