SURGICAL EVALUATION OF A YOUNG PATIENT WITH LYNCH SYNDROME

Abstract

Lynch syndrome is a genetic condition that increases the risk of developing colorectal cancer and other types of cancer, especially in young individuals. This syndrome is caused by mutations in genes responsible for DNA repair, which leads to the accumulation of genetic errors in cells. Surgical evaluation of young patients with Lynch syndrome is important to prevent or treat colorectal cancer, which can be fatal if not detected early. Objective: to compare different surgical options for young patients with Lynch syndrome and evaluate their benefits and risks. Methodology: To carry out this review, a methodology based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was used, which consists of a series of criteria to guarantee the quality and transparency of the studies reviewed. The PubMed, Scielo and Web of Science databases were consulted, using the following descriptors: “Lynch syndrome”, “colorectal cancer”, “surgery”, “young” and “evaluation”. Only articles published in the last 10 years were included, which addressed patients with Lynch syndrome under the age of 50, who underwent some type of surgery for colorectal cancer. Articles that did not present patients' clinical data, that were reviews or case reports, or that were not available in full were excluded. Results: 12 articles were selected. The most common surgery performed by patients with Lynch syndrome was total colectomy with ileorectal anastomosis, which consists of removing the entire colon and joining the ileum with the rectum. This surgery has the advantage of reducing the risk of recurrence of colorectal cancer and avoiding the need for an external ileal pouch. However, this surgery can also cause complications such as diarrhea, fecal incontinence, infection and anastomotic stricture. Another surgical option for patients with Lynch syndrome is segmental colectomy, which involves removing only the part of the colon affected by the tumor. This surgery has the advantage of preserving more intestinal tissue and causing fewer changes in intestinal function. However, this surgery also has the disadvantage of increasing the risk of developing new tumors in the remaining colon, which requires more rigorous and frequent monitoring. Conclusion: The conclusion of this review is that there is no single ideal surgical option for young patients with Lynch syndrome, but rather different alternatives that must be considered together with the doctor and the patient. Each surgery has its pros and cons, which must be evaluated according to the individual characteristics of the patients, such as the stage of the cancer, the location of the tumor, the presence of symptoms and personal preferences.