@harrisonedwards this could be multiple syndromes though right?
I think Muir-Torre (i.e. Lynch) and Peutz-Jehgers are the next highest risk after Gardner (FAP), and prophylactic colectomy doesn’t seem to be usually indicated for them:
UpToDate on Lynch syndrome: “Prophylactic colectomy for mutation carriers who have an endoscopically normal colon is not routinely recommended but is reserved for patients who are unable or unwilling to undergo routine CRC surveillance”.
There is also this recent article which is quite comprehensive: https://gut.bmj.com/content/69/3/411
FAP: “We recommend that for patients with FAP who are undergoing colonoscopic surveillance, relative indications for surgery are polyps > 10 mm in diameter, high grade dysplasia within polyps and a significant increase in polyp burden between screening examinations … For most patients the choice of surgery will be between total colectomy with ileorectal anastomosis (IRA) and proctocolectomy and ileal pouch anal anastomosis (IPAA).”
“We suggest that for LS [Lynch syndrome] patients with MLH1 or MSH2 mutations who develop colon cancer or colonic neoplasia not amenable to endoscopic control, the decision to perform segmental versus total/near total colectomy should balance the risks of metachronous cancer, the functional consequences of surgery, the patient’s age and patient’s wishes.” So they recommend considering a larger resection for diagnosed cancer than you might otherwise, but not primary prophylactic resection. For MSH6 and PMS2, they say there’s insufficient evidence to extend the resection.
They discuss Peutz-Jehgers syndrome and their screening/treatment recommendations, but don’t mention prophylactic surgery.
good to know! Seems reasonable to add then!