resection may be considered. Examples include an unhealthy patient who cannot tol­erate an extended resection or the physiologic consequences after a total colectomy (e.g. renal impairment where dehydration could lead to renal failure); other health conditions that limit life expectancy more so than the risk of a second Lynch-related colorectal can­cer; stage IV colon cancer such that risk of mortality from current disease is greater than that from metachronous cancer. Another indi­cation is patient choice in the setting of ade­quate information and counseling. There are patients who absolutely refuse the extended prophylactic colectomy and accept the need for continued intense surveillance and meta­chronous risk. For rectal cancers, the same conditions above apply, but additional con­siderations are given to sphincter function. Patients with weak sphincter function may have better bowel function after proctectomy alone compared to IPAA. A TPC and end ileostomy could also be considered for patients with poor sphincter function. One undebatable issue in the decision to do a seg­mental colectomy is the patient’s understand­ing and willingness to undergo annual colonoscopic surveillance. If a patient is not willing or non-compliant with surveillance recommendations, this is a contraindication to segmental colectomy.