Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis

Abstract

PurposeWe evaluated the short- and long-term outcomes of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC/IPAA) for treatment of familial adenomatous polyposis (FAP). Also, we assessed the oncologic outcomes in FAP patients with coexisting malignancy.MethodsFrom August 1999 to September 2010, 43 FAP patients with or without coexisting malignancy underwent TPC/IPAA by a laparoscopic-assisted or hand-assisted laparoscopic surgery.ResultsThe median age was 33 years (range, 18 to 58 years) at the time of operation. IPAA was performed by a hand-sewn method in 21 patients (48.8%). The median operative time was 300 minutes (range, 135 to 610 minutes), which reached a plateau after 22 operations. Early postoperative complications within 30 days occurred in 7 patients (16.3%) and long-term morbidity occurred in 15 patients (34.9%) including 6 (14.0%) with desmoid tumors and 3 (7.0%) who required operative treatment. Twenty-two patients (51.2%) were diagnosed with coexisting colorectal malignancy. The median follow-up was 58.5 months (range, 7.9 to 97.8 months). There was only 1 case of local recurrence in the pelvic cavity. No cases of adenocarcinoma at the residual rectal mucosa developed. 5-year disease-free survival rate for 22 patients who had coexisting malignancy was 86.5% and 5-year overall survival rate was 92.6%. Three patients died from pulmonary or hepatic metastasis.ConclusionLaparoscopic TPC/IPAA in patients with FAP is feasible and offers favorable postoperative outcomes. It also delivered acceptable oncological outcomes in patients with coexisting malignancy. Therefore, laparoscopic TPC/IPAA may be a favorable treatment option for FAP.

Risk of desmoid tumours after open and laparoscopic colectomy in patients with familial adenomatous polyposis

“…To date, only sparse data have been reported on the occurrence of DT in patients with FAP after laparoscopic surgery. The present study showed an overall incidence of DT of 15·0 per cent after prophylactic surgery, consistent with previous reports.…”

Hand-assisted hybrid laparoscopic–robotic total proctocolectomy with ileal pouch–anal anastomosis

“…In fact from our data, although limited by the small sample, the operative time, complications, and functional aspects are promising when compared with the major recent reports published in literature about laparoscopic total proctocolectomy [25][26][27][28][29][30][31]. The comparative results are shown in the Table 3.…”

The role of hand-assisted laparoscopic surgery in total colectomy for colonic inertia: a retrospective study

“…With the special hand port device, surgeons regain tactile feedback, can complete blunt dissection, retraction, control of bleeding, and organ removal simply [17]. Especially, if the surgeon is inexperienced in laparoscopic operations, HALS in some difficult parts of the operation may be useful [18]. …”