To investigate the risk of metachronous colorectal cancer and high risk colorectal adenoma after colectomy for colon neoplasma and its impact on survival in a cohort of patients of families fulfilling the Amsterdam criteria.

Thirty-four patients of families fulfilling the Amsterdam criteria who underwent colectomy in the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University for colon neoplasm was identified from a single-institution hereditary colorectal cancer database. The demographics, clinicopathological characteristics of the index CRC, and the follow-up data about survival and metachronous colorectal neoplasma were analyzed.

No metachronous colorectal neoplasm occurred in six patients who underwent total or subtotal colectomy during a median follow-up of 122 months. Of twenty-eight patients who underwent segmental colectomy, ten developed metachronous colorectal cancer, and one adenoma that need abdominal resection during a median follow-up of eighty-two months. The cumulative risk of metachronous colorectal neoplasma was 24.1% at 5 years and 48.2% at 10 years in segmental colectomy patients, which was significantly different than that in total colectomy patients (P=0.047). The overall cumulative survival was 100% at 5 years and 85.6% at 10 years. No significant difference in overall survival was observed between segmental colectomy and total colectomy (P=0.306), or between metachronous colorectal neoplasma positive and free patients (P=0.901). Patient gender, age, past history of colorectal surgery for colorectal cancer, tumor site, differentiation or stage were not risk factors for metachronous colorectal neoplasma after segmental colectomy.

Patients of families meeting Amsterdam criteria carry a high risk of metachronous colorectal carcinoma and high risk adenoma. Total colectomy, compared with segmental colectomy, can reduce metachronous colorectal tumor risk, however dose not significantly improve overall survival.