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01.01.2009 | original article

Rectal and Pouch Recurrences After Surgical Treatment for Familial Adenomatous Polyposis

verfasst von: Fabio Guilherme Campos, Antonio Rocco Imperiale, Víctor Edmond Seid, Rodrigo Oliva Perez, Afonso Henrique da Silva e Sousa Jr, Desidério Roberto Kiss, Angelita Habr-Gama, Ivan Cecconello

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 1/2009

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Abstract

Background

Familial adenomatous polyposis (FAP) is a genetic disease characterized by multiple adenomatous colorectal polyps and different extracolonic manifestations (ECM). The present work is aimed to analyze the outcome after surgical treatment regarding complications and cancer recurrence.

Methods

Charts from patients treated between 1977 and 2006 were retrospectively analyzed. Clinical and endoscopic data, results of treatment, pathological reports and information about recurrence were collected.

Results

Eighty-eight patients (41 men [46.6%] and 47 women [53.4%]) were assisted. At diagnosis, associated colorectal cancer (CRC) was detected in 53 patients (60.2%), whose average age was higher than those without CRC (40.0 vs. 29.5 years). At colonoscopy, polyposis was classified as attenuated in 12 patients (14.3%). Surgical treatment consisted in total proctocolectomy with ileostomy (PCI, 15 [17.4%]), restorative proctocolectomy (RPC, 27 [31.4%]), total colectomy with ileal-rectum anastomosis (IRA, 42 [48.8%]), palliative segmental resection (1 [1.2%]) and internal bypass (1 [1.2%]). Two patients were not operated on due to religious reasons and advanced disease. Complications occurred in 25 patients (29.0%), more commonly after RPC (48.1%). There was no operative mortality. Local or distant metastases were detected in six (11.3%) patients with CRC treated to cure. During the follow-up of 36 IRA, cancer developed in the rectal cuff in six patients (16.6%), whose average age was higher than in patients without rectal recurrence (45.8 vs. 36.6 years). Five of them have had colonic cancer in the resected specimen. Among the 26 patients followed after RPC, cancer in the ileal pouch developed in 1 (3.8%).

Conclusions

(1) Within the present series, FAP patients presented a high incidence of associated CRC and diagnosis was generally established after the third decade of life; (2) operative complications occurred in about one third of the patients, being more frequent after the confection of an ileal reservoir; (3) rectal cancer after IRA was detected in 16.6% of patients and it was associated with greater age and previous colonic carcinoma; (4) both continuous and long-term surveillance of the rectal stump and ileal pouch are necessary during follow-up.

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Titel: Rectal and Pouch Recurrences After Surgical Treatment for Familial Adenomatous Polyposis
verfasst von: Fabio Guilherme Campos
Antonio Rocco Imperiale
Víctor Edmond Seid
Rodrigo Oliva Perez
Afonso Henrique da Silva e Sousa Jr
Desidério Roberto Kiss
Angelita Habr-Gama
Ivan Cecconello
Publikationsdatum: 01.01.2009
Verlag: Springer-Verlag
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 1/2009
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0606-8

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Abstract

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Conclusions

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