Decision analysis in the surgical treatment of colorectal cancer due to a mismatch repair gene defect
- W H de Vos tot Nederveen Cappel2,
- E Buskens3,
- P van Duijvendijk4,
- A Cats6,
- F H Menko8,
- G Griffioen2,
- J F Slors5,
- F M Nagengast7,
- J H Kleibeuker9,
- H F A Vasen1,2
- 1Department of Gastroenterology, Leiden University Medical Centre Leiden, the Netherlands, and the Netherlands Foundation for the Detection of Hereditary Tumours, Leiden University Medical Centre, Leiden, the Netherlands
- 2Department of Gastroenterology, Leiden University Medical Centre Leiden, the Netherlands
- 3Department of Clinical Epidemiology, Utrecht University Medical Centre, the Netherlands
- 4Department of Surgery, Gelre Ziekenhuizen Apeldoorn, the Netherlands
- 5Department of Surgery, Amsterdam Medical Centre, Amsterdam, the Netherlands
- 6Department of Gastroenterology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- 7Department of Gastroenterology, Nijmegen University Hospital, Nijmegen, the Netherlands
- 8Department of Clinical and Human Genetics, VU Medical Centre Amsterdam, the Netherlands
- 9Department of Gastroenterology, Groningen University Hospital, Groningen, the Netherlands
- Correspondence to:
Dr H F A Vasen
the Netherlands Foundation for the Detection of Hereditary Tumours, Leiden University Medical Centre, Rijnsburgerweg 10, “Poortgebouw Zuid”, 2333 AA Leiden, the Netherlands;
- Accepted 8 July 2003
Background: In view of the high risk of developing a new primary colorectal carcinoma (CRC), subtotal colectomy rather than segmental resection or hemicolectomy is the preferred treatment in hereditary non-polyposis colorectal cancer (HNPCC) patients. Subtotal colectomy however implies a substantial decrease in quality of life. To date, colonoscopic surveillance has been shown to reduce CRC occurrence.
Aims: To compare the potential health effects in terms of life expectancy (LE) for patients undergoing subtotal colectomy or hemicolectomy for CRC.
Methods: A decision analysis (Markov) model was created. Information on the 10 year risk of CRC after subtotal colectomy (4%) and hemicolectomy (16%) and stages of CRCs detected within a two year surveillance interval (32% Dukes’ A, 54% Dukes’ B, and 14% Dukes’ C) were derived from two cohort studies. Five year survival rates used for the different Dukes stages (A, B, and C) were 98%, 80%, and 60%, respectively. Remaining LE values were calculated for hypothetical cohorts with an age at CRC diagnosis of 27, 47, and 67 years, respectively. Remaining LE values were also calculated for patients with CRC of Dukes’ stage A.
Results: The overall LE gain of subtotal colectomy compared with hemicolectomy at ages 27, 47, and 67 was 2.3, 1, and 0.3 years, respectively. Specifically for Dukes’ stage A, this would be 3.4, 1.5, and 0.4 years.
Conclusions: Unless surveillance results improve, subtotal colectomy still seems the preferred treatment for CRC in HNPCC in view of the difference in LE. For older patients, hemicolectomy may be an option as there is no appreciable difference in LE.
- HNPCC, hereditary non-polyposis colorectal cancer
- CRC, colorectal cancer
- MMR, mismatch repair
- QOL, quality of life
- LE, life expectancy
Meeting presentations: poster presentation at the 2002 Annual Meeting at Digestive Disease Week, DDW, San Francisco, California, May 2002; oral presentation at the 2002 Spring Meeting of the Netherlands Society of Gastroenterology, Veldhoven, the Netherlands, March, 2002.