title: Is there a role for prophylactic colectomy in Lynch syndrome patients with inflammatory bowel disease?
abstract: OBJECTIVE
  Lynch syndrome and chronic inflammatory bowel disease are two important risk factors for colorectal cancer. It is unclear whether Lynch syndrome patients with inflammatory bowel disease are at sufficiently increased risk for colorectal cancer to warrant prophylactic colectomy. This study aims to identify all cases of Lynch syndrome and concurrent inflammatory bowel disease in a large familial gastrointestinal cancer registry, define incidence of colorectal cancer, and characterize mismatch repair protein gene mutation status and inflammatory bowel disease-associated colorectal cancer risk factors.
  
  
  METHODS
  We retrospectively identified and collected clinical data for all cases with confirmed diagnoses of Lynch syndrome and inflammatory bowel disease in the Familial Gastrointestinal Cancer Registry at Mount Sinai Hospital in Toronto, Canada.
  
  
  RESULTS
  Twelve cases of confirmed Lynch syndrome, and concurrent inflammatory bowel disease were identified. Four cases developed colorectal cancer. An additional five cases had colectomy; one was performed for severe colitis, and four were performed for low-grade dysplasia. None of these surgical specimens contained malignancy or high-grade dysplasia.
  
  
  CONCLUSIONS
  The presentation of Lynch syndrome with inflammatory bowel disease is uncommon and not well described in the literature. This small but important series of twelve cases is the largest reported to date. In this series, patients with Lynch syndrome and concurrent inflammatory bowel disease do not appear to have sufficiently increased risk for colorectal cancer to recommend prophylactic surgery. Therefore, the decision to surgery should continue to be guided by surgical indications for each disease. Further evaluation of this important area will require multi-institutional input.
authors.affiliation: Lunenfeld-Tanenbaum Research Institute, 60 Murray Street Box 31 Rm L6-304G, Toronto, ON, M5T3L9, Canada. kate.mcnamara@downstate.edu.
authors.forename: Kate L
authors.initials: KL
authors.lastname: McNamara
authors.affiliation: Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, L3-012, 60 Murray Street 3rd Floor, Toronto, ON, M5T3L9, Canada.
authors.forename: Melyssa D
authors.initials: MD
authors.lastname: Aronson
authors.affiliation: Lunenfeld-Tanenbaum Research Institute, 60 Murray Street Box 31 Rm L6-304G, Toronto, ON, M5T3L9, Canada.|Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, L3-012, 60 Murray Street 3rd Floor, Toronto, ON, M5T3L9, Canada.
authors.forename: Zane
authors.initials: Z
authors.lastname: Cohen
mesh_terms: D000328:Adult; D003082:Colectomy; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008875:Middle Aged; D009154:Mutation / Q000235:genetics
keywords: Colon and rectal surgery; Colorectal cancer; HNPCC; Inflammatory bowel disease; Lynch syndrome