From the Guidelines
A right hemicolectomy should be offered for high-grade adenomatous mucosal neoplasia (HAMN) when endoscopic resection is not feasible or when there are concerning features suggesting invasive cancer, as this approach provides both definitive treatment and accurate staging through examination of regional lymph nodes, thereby reducing the risk of morbidity and mortality. When considering the management of HAMN, several key factors must be taken into account, including the size and location of the lesion, the presence of high-grade dysplasia or invasive cancer, and the patient's overall health and preferences 1. The following scenarios are indicative of the need for a right hemicolectomy:
- Large lesions (typically >2-3 cm) that cannot be removed endoscopically
- Lesions with poor lifting sign during attempted endoscopic removal
- Lesions in anatomically difficult locations (such as the cecum or ileocecal valve)
- Suspicion of submucosal invasion based on endoscopic appearance (irregular surface, ulceration, firm consistency)
- Histopathology from biopsies or incomplete polypectomy showing high-grade dysplasia with features concerning for invasive carcinoma It is essential to weigh the benefits of surgical resection against the potential risks and consider the patient's individual circumstances, including their age, underlying health conditions, and preferences 1. A multidisciplinary discussion involving gastroenterologists, surgeons, and pathologists is crucial to ensure the appropriate management strategy for each individual patient. Ultimately, the decision to perform a right hemicolectomy should be based on a careful consideration of the potential benefits and risks, with the goal of minimizing morbidity and mortality while maximizing quality of life.
From the Research
Decision-Making for Right Hemicolectomy in HAMN
There are no research papers provided that directly address the question of when to offer a right hemicolectomy for HAMN. The studies provided focus on the management of familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP), discussing the importance of prophylactic colectomy, endoscopic surveillance, and surgical considerations.
Key Points from Relevant Studies
- The decision-making process for surgical treatment in FAP patients should consider factors such as age, genotype, family history, sphincter function, and the presence or risk of desmoid disease 2.
- Prophylactic colectomy is indicated in FAP and less often in MAP, followed by lifelong endoscopic surveillance of the retained rectum or ileal pouch 3.
- Regular endoscopic surveillance is recommended for patients with FAP, not only after ileorectal anastomosis but also after proctocolectomy with ileal pouch-anal anastomosis 4, 5, 6.
- Surgical management of malignancy or advanced upper tract manifestations is needed in patients with FAP 5.
Implications for HAMN Management
Although the provided studies do not directly address HAMN, they highlight the importance of individualized decision-making and regular surveillance in the management of hereditary conditions with an increased risk of colorectal cancer. However, without specific research on HAMN, it is not possible to provide evidence-based guidance on when to offer a right hemicolectomy for this condition.