Colectomy and desmoid tumours in familial adenomatous polyposis: a systematic review and meta-analysis

Abstract

Desmoid tumours (DT) are one of the main causes of death in patients with familial adenomatous polyposis (FAP). Surgical trauma is a risk factor for DT, yet a colectomy is inevitable in FAP to prevent colorectal cancer. This systematic review and meta-analysis aimed to synthesize the available evidence on DT risk related to type, approach and timing of colectomy. A search was performed in MEDLINE, EMBASE and the Cochrane Library. Studies were considered eligible when DT incidence was reported after different types, approaches and timing of colectomy. Twenty studies including 6452 FAP patients were selected, all observational. No significant difference in DT incidence was observed after IRA versus IPAA (OR 0.99, 95% CI 0.69–1.42) and after open versus laparoscopic colectomy (OR 0.88, 95% CI 0.42–1.86). Conflicting DT incidences were seen after early versus late colectomy and when analysing open versus laparoscopic colectomy according to colectomy type. Three studies reported a (non-significantly) higher DT incidence after laparoscopic IPAA compared to laparoscopic IRA, with OR varying between 1.77 and 4.09. A significantly higher DT incidence was observed in patients with a history of abdominal surgery (OR 3.40, 95% CI 1.64–7.03, p = 0.001). Current literature does not allow to state firmly whether type, approach, or timing of colectomy affects DT risk in FAP patients. Fewer DT were observed after laparoscopic IRA compared to laparoscopic IPAA, suggesting laparoscopic IRA as the preferred choice if appropriate considering rectal polyp burden. PROSPERO registration number CRD42020161424.

Management of Desmoid Disease in Familial Adenomatous Polyposis

“…18 Studies looking at whether operative approach (open vs. laparoscopic surgery) contributes to desmoid formation are also inconclusive. A recent meta-analysis showed no significant difference in open versus laparoscopic surgery, 19 while a retrospective review from the St. Mark's Polyposis Registry showed a slightly lower association of desmoid development with laparoscopic TAC/IRA compared with open TAC/IRA. 20 It is the authors' strategy, therefore, in our patients at high risk for desmoid formation to delay surgery as long as is possible and preferentially perform laparoscopic TAC/IRA if the rectum polyp burden can be safely managed endoscopically.…”

“…18 Studies looking at whether operative approach (open vs. laparoscopic surgery) contributes to desmoid formation are also inconclusive. A recent meta-analysis showed no significant difference in open versus laparoscopic surgery,19 while a retrospective review from the St. Mark's Polyposis Registry showed a slightly lower association of desmoid development with laparoscopic TAC/IRA compared with open TAC/IRA.…”

Recent Advances and Current Management for Desmoid Tumor Associated with Familial Adenomatous Polyposis

“…Furthermore, Konishi et al [24] reported that the incidence of DTs was comparable between laparoscopic and open approaches in both total proctocolectomy with IPAA and total colectomy with ileorectal anastomosis (IRA). A very recent report of a systematic review and meta-analysis by Aelvoet et al [48] demonstrated that no significant difference in DT incidence was observed after IRA versus IPAA (OR 0.99, 95% CI 0.69-1.42) and after open versus laparoscopic colectomy (OR 0.88, 95% CI 0.42-1.86). Another systematic review by Xie et al [49] reported that there was no significant difference in the incidence of DTs between IRA and IPAA.…”

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Inherited Adenomatous Polyposis Syndromes

“…[136][137][138][139] However, conflicting reports suggest that the operative approach and extent of operation result in a similar risk for desmoid formation. [140][141][142][143] Based on the body of retrospective literature with its inherent selection bias, the risk of desmoid tumors after surgical trauma remains unclear and, likely, multifactorial. Other factors, such as APC genotype, family history, and sex, rather than surgical trauma alone, may influence desmoid formation in patients with FAP.…”