The French Ad-Hoc Committee on Hereditary Non-polyposis Colon Cancer (HNPCC) management meeting on behalf of the French Health Minister has recently released its statement.¹ The report on prophylactic colorectal resections for HNPCC related adenocarcinomas (Gut 2003;52:1752–5) is in contrast with ours and we would like to discuss this point.

Use of decision analysis models is a smart approach in dealing with such complex situations. However, life expectancy related to the occurrence of metachronous colorectal carcinoma should be balanced against the negative impact on quality of life in the case of prophylactic extensive colorectal resections. Thus quality adjusted life expectancy, integrating the individual patient’s choice,² might be a more accurate approach. Comprehensive, fair, and loyal information of what the patient can hope for is mandatory to fulfil the requirements of patient autonomy in such a shared decision. From …