• T T Seppälä, A Latchford, I Negoi, A Sampaio Soares, R Jimenez-Rodriguez, L Sánchez-Guillén, D G Evans, N Ryan, E J Crosbie, M Dominguez-Valentin, J Burn, M Kloor, Knebel DoeberitzM vonMVDepartment of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Germany.Cooperation Unit Applied Tumour Biology, German Cancer Research Centre, Heidelberg, Germany., DuijnhovenF J B vanFJBVDivision of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands., P Quirke, J R Sampson, P Møller, G Möslein, and European Hereditary Tumour Group (EHTG) and European Society of Coloproctology (ESCP).
• Department of Surgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
• Br J Surg. 2021 May 27; 108 (5): 484498484-498.

BackgroundLynch syndrome is the most common genetic predisposition for hereditary cancer but remains underdiagnosed. Large prospective observational studies have recently increased understanding of the effectiveness of colonoscopic surveillance and the heterogeneity of cancer risk between genotypes. The need for gene- and gender-specific guidelines has been acknowledged.MethodsThe European Hereditary Tumour Group (EHTG) and European Society of Coloproctology (ESCP) developed a multidisciplinary working group consisting of surgeons, clinical and molecular geneticists, pathologists, epidemiologists, gastroenterologists, and patient representation to conduct a graded evidence review. The previous Mallorca guideline format was used to revise the clinical guidance. Consensus for the guidance statements was acquired by three Delphi voting rounds.ResultsRecommendations for clinical and molecular identification of Lynch syndrome, surgical and endoscopic management of Lynch syndrome-associated colorectal cancer, and preventive measures for cancer were produced. The emphasis was on surgical and gastroenterological aspects of the cancer spectrum. Manchester consensus guidelines for gynaecological management were endorsed. Executive and layperson summaries were provided.ConclusionThe recommendations from the EHTG and ESCP for identification of patients with Lynch syndrome, colorectal surveillance, surgical management of colorectal cancer, lifestyle and chemoprevention in Lynch syndrome that reached a consensus (at least 80 per cent) are presented.© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.

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