Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis

Thompson‐Fawcett, Mark; Marcus, Victoria; Redston, Mark; Cohen, Zane; McLeod, Robin S.

doi:10.1007/bf02234731

Cited by 82 publications

(59 citation statements)

References 41 publications

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“…The risk of adenomas in the ileal pouch is 7% to 16% after 5 years, 35% to 42% after 10 years, and 75% after 15 years. The diagnosis of pouch carcinoma was made between 3 to 20 years after pouch construction (17,18 Adenocarcinomas have also been found in end ileostomies; for this reason annual endoscopic surveillance of reservoir, terminal ileum and anastomosis is important (19,20). Ileal pouch adenoma or adenoma in the ileostomy was not seen in any patients in our series.…”

Section: Resultsmentioning

confidence: 62%

The Surgical Treatment Options for Familial Adenomatous Polyposis: A Clinic Experience

Tarcan¹,

Turanlı²,

Güler³

et al. 2016

Acta Oncol Tur.

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ÖZET Amaç: Ailesel adenomatöz polipoziste (AAP) cerrahi tedavi, abdominal kolektomi-ileorektal anastomoz (IRA), restoratif proktokolektomi-ileal J poş anal anastomoz (IPAA) ve total proktokolektomi-kalıcı ileostomiyi içerir. Bu çalışma ile hangi tip cerrahi yöntemin en iyi seçenek olduğu irdelendi. Gereç ve Yöntemler: Ailesel adenomatöz polipozis tanısıyla 2004-2014 yılları arasında aynı merkezde cerrahi girişim uygulanmış 20 hasta çalışmaya alındı. Hastalar uygulanan ameliyat türüne göre 3 gruba ayrıldı. Demografik özellikler, ameliyat bulguları, patoloji sonuçları ve klinik seyirlerine ilişkin veriler geriye dönük olarak hastane kayıtlarından elde edildi. Bulgular: Yirmi hastada AAP tanısı kolonoskopi ve patoloji raporuna dayanılarak konuldu. Bunların 15'inde kanser gelişmişken 5 hastada kolonoskopik taramada kanser henüz gelişmeden tanı konuldu. Kanser gelişen ve gelişmeyen hastaların ortanca yaşı sırasıyla 37 ve 20 yaş. Dört hastaya IPAA, 4 hastaya IRA ve geri kalan 12 hastaya total proktokolektomi kalıcı ileostomi uygulandı. Hastaların hepsinde 100 ve üzerinde kolonda polip vardı. Hastalar ortanca 38 aya takip edildi. Bu takip esnasında 8 hastada (%40.0) tekrarlayan veya metastatik hastalık gelişti. Bunlar; 4 hastada uzak metastaz, 3 hastada rektum kanseri (hepsine daha önce IRA yapılmış) ve bir hastada ise desmoid tümör şeklindeydi. Ayrıca IRA yapılmış 1 hastada rektumda adenom gelişti. Ileal poş adenomu ya da ileostomide adenom gelişimi izlenmedi. Dört hasta hastalığa bağlı kaybedildi. Bunlardan 3'ü metastatik hastalık gelişimine bağlıyken kalan 1 hastada dev desmoid tümörün neden olduğu böbrek yetmezliği ölüm sebebiydi. Sonuç: Ameliyat öncesi kanser tanısı konulmuş klasik AAP hastalarında cerrahi yöntem olarak abdominal kolektomi-IRA seçimi iyi bir seçenek olmayabilir. Ancak çalışmanın az sayıda hastayı kapsadığı da göz önünde bulundurulmalıdır. Anahtar Kelimeler: Ailesel adenomatöz polipozis, kolektomi, proktokolektomi, karsinom ABSTRACT Objective: Familial adenomatous polyposis (FAP) is treated by abdominal colectomy with ileorectal anastomosis (IRA), restorative proctocolectomy with ileal J-pouch anal anastomosis (IPAA), and total proctocolectomy with ileostomy. This study investigated question is what type of surgery is better. Material and Method: Twenty FAP patients, who underwent surgery in a single hospital between 2004 and 2014, were included. Patients were classified in 3 groups according to the operation procedures. Demographic, surgical, pathological, and outcome data were analyzed from hospital records retrospectively. Results: Overall 20 patients were included, 15 index patients, and 5 relatives diagnosed by screening. Median age of patients with or without colorectal cancer was 37 and 20 years respectively. Four patients were treated by IPAA, 4 by IRA, and 12 by proctocolectomy. All patients presented with 100 or more colonic polyps. The median follow-up time was 38 months. During the follow-up period, 8 (40.0%) patients developed recurrent or metastatic disease. There were; distant metast...

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Section: Resultsmentioning

confidence: 62%

The Surgical Treatment Options for Familial Adenomatous Polyposis: A Clinic Experience

Tarcan¹,

Turanlı²,

Güler³

et al. 2016

Acta Oncol Tur.

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“…Although there is no agreement to the frequency of examination, some authors suggest a 3-years interval when polyps are not detected in the pouch, 2-3 years when they are found and frequent follow-up in cases of advanced or numerous adenomas (33) .…”

Section: Discussionmentioning

confidence: 98%

“…The development of pouch adenomas has been reported in variable incidences ranging from 4% to 50% of the cases (29,33) . Moreover, publications of adenocarcinoma cases (9,37) suggest that the risk of malignization is not abolished.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy?

Campos

Perez

Imperiale

et al. 2009

Arq. Gastroenterol.

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-Context -Controversy regarding the best operative choice for familial adenomatous polyposis lays between the morbidity of restorative proctocolectomy and the supposed mortality due to rectal cancer after ileorectal anastomosis. Objectives -To evaluate operative complications and oncological outcome after ileorectal anastomosis and restorative proctocolectomy. Among the 26 patients followed after restorative proctocolectomy, it was found cancer in the ileal pouch in 1 (3.8%). Conclusions -1. Operative complications occurred in about one third of the patients, being more frequently after the confection of ileal reservoir; 2. greater age and previous colonic carcinoma were associated with the development of rectal cancer after ileorectal anastomosis; 3. patients treated by restorative proctocolectomy are not free from the risk of pouch degeneration; 4. the disease complexity and the various risk factors (clinical, endoscopic, genetic) indicate that the best choice for operative treatment should be based on individual features discussed by a specialist; 5. all patients require continuous and long-term surveillance during postoperative follow-up.

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“…Therefore, long- term surveillance of the remaining rectum is required after stapled IPAA and after hand-sewn IPAA. Adenomas in the ileal pouch have been reported to develop in 6.7-74% of patients after IPAA [26][27][28][29] , and cancer has also been reported to develop 30,31) . Therefore, long-term surveillance is necessary.…”

Section: ) Surveillance Specific To Proctocolectomy (Colectomy)mentioning

confidence: 99%

“…Hideyuki Ishida 1) , Tatsuro Yamaguchi 2) , Kohji Tanakaya 3) , Kiwamu Akagi 4) , Yasuhiro Inoue 5) , Kensuke Kumamoto 6) , Hideki Shimodaira 7) , Shigeki Sekine 8) , Toshiaki Tanaka 9) , Akiko Chino 10) , Naohiro Tomita 11) , Takeshi Nakajima 12) , Hirotoshi Hasegawa 13) , Takao Hinoi 14) , Akira Hirasawa 15) , Yasuyuki Miyakura 16) , Yoshie Murakami 17) , Kei Muro 18) , Yoichi Ajioka 19) , Yojiro Hashiguchi 20) , Yoshinori Ito 21) , Yutaka Saito 22) , Tetsuya Hamaguchi 23) , Megumi Ishiguro 24) , Soichiro Ishihara 9) , Yukihide Kanemitsu 25) , Hiroshi Kawano 26) , Yusuke Kinugasa 27) , Norihiro Kokudo 28) , Keiko Murofushi 29) , Takako Nakajima , Narikazu Boku 23) , Takahiro Fujimori 39) , Michio Itabashi 40) , Nobuo Koinuma 41) , Takayuki Morita 42) , Genichi Nishimura 43) , Yuh Sakata 44) , Yasuhiro Shimada 45) , Keiichi Takahashi 2) , Shinji Tanaka 46) , Osamu Tsuruta 47) , Toshiharu Yamaguchi 48)…”

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Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2016 for the Clinical Practice of Hereditary Colorectal Cancer (Translated Version)

Ishida

Yamaguchi

Tanakaya

et al. 2018

J Anus Rectum Colon

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Hereditary colorectal cancer accounts for less than 5% of all colorectal cancer cases. Some of the unique characteristics that are commonly encountered in cases of hereditary colorectal cancer include early age at onset, synchronous/metachronous occurrence of the cancer, and association with multiple cancers in other organs, necessitating different management from sporadic colorectal cancer. While the diagnosis of familial adenomatous polyposis might be easy because usually 100 or more adenomas that develop in the colonic mucosa are in this condition, Lynch syndrome, which is the most commonly associated disease with hereditary colorectal cancer, is often missed in daily medical practice because of its relatively poorly defined clinical characteristics. In addition, the disease concept and diagnostic criteria for Lynch syndrome, which was once called hereditary non‐polyposis colorectal cancer, have changed over time with continual research, thereby possibly creating confusion in clinical practice. Under these circumstances, the JSCCR Guideline Committee has developed the “JSCCR Guidelines 2016 for the Clinical Practice of Hereditary Colorectal Cancer (HCRC)," to allow delivery of appropriate medical care in daily practice to patients with familial adenomatous polyposis, Lynch syndrome, or other related diseases. The JSCCR Guidelines 2016 for HCRC were prepared by consensus reached among members of the JSCCR Guideline Committee, based on a careful review of the evidence retrieved from literature searches, and considering the medical health insurance system and actual clinical practice settings in Japan. Herein, we present the English version of the JSCCR Guidelines 2016 for HCRC.

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Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis

Abstract: Adenomatous polyps occur frequently in ileal pouches. These findings are of concern, and therefore, regular surveillance seems warranted until the natural history of these adenomatous polyps is determined.

Cited by 82 publications

References 41 publications

The Surgical Treatment Options for Familial Adenomatous Polyposis: A Clinic Experience

The Surgical Treatment Options for Familial Adenomatous Polyposis: A Clinic Experience

Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy?

Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2016 for the Clinical Practice of Hereditary Colorectal Cancer (Translated Version)

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