Female fecundity before and after operation for familial adenomatous polyposis

Olsen, Kasper Ørding; Juul, Svend; Bülow, Steffen; Järvinen, Heikki; Bakka, Arne; Björk, Jan; Øresland, Tom; Laurberg, Søren

doi:10.1002/bjs.4082

Cited by 243 publications

(123 citation statements)

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“…As previous attempts to start a multicenter randomized controlled trial have failed, a non-concurrent cohort study, on an intention-to-treat basis, has started in three institutes to afford the best possible comparison. Comparison of the IRA and IPAA to non-operated control patients has shown that female fecundity is significantly reduced in IPAA and not in IRA [10]. This is explained by the difference in pelvic dissection (and not the comparable manipulation during laparotomy).…”

Section: Discussionmentioning

confidence: 99%

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Ileo-Neorectal Anastomosis: Medium- and Long-Term Follow-Up of 37 Patients

Laarhoven

Hueting²,

Schipper³

et al. 2004

Dig Surg

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Background: Ileo-neorectal anastomosis (INRA), an alternative restorative procedure, was developed to reduce the pouch-related complication rate with an (at least) equal functional result. Methods: For this surgical outcome, data of all INRA patients, including bowel function and complications, were prospectively recorded. The reservoir capacity was determined repeatedly by physiologic tests. The anal sphincter complex was assessed by manometry and ultrasound examination. Evaluation of the neorectal mucosa was performed by endoscopy. Results: An INRA procedure was carried out in 39/53 selected patients (47 ulcerative colitis and 6 familial adenomatous polyposis). Fourteen UC cases were converted to ileal pouch anal anastomosis or proctectomy only, because of impossibility to completely remove the rectal mucosa or short of length of the rectal stump. The median operation time for INRA was 323 min (range 240–518), with 1,400 ml blood loss (400–4,500). The reservoirs were permanently defunctioned in 2 patients – one because of reclassification into Crohn’s disease, and one with pouchitis refractory to medical treatment. In 18 out of 37 cases, web-like stenoses occurred at the mucosa-anal level, which were treated by single (9) or repeated (5) dilatation or surgical stenoplasty (2). No pouch-related complications like pelvic sepsis, fistula or sexual dysfunction occurred. Thirteen patients had episodes of ‘pouchitis’, successfully treated with antibiotics, and 7 other cases, with functioning reservoirs, also had proximal ‘non-specific’ (i.e. no histological criteria of Crohn’s disease found) small bowel inflammation. The median bowel frequency decreased from 15×/24 h initially to 7×/24 h at 2 years. Continence was perfect in 24/37 cases. Twelve out of 37 cases had occasional nocturnal soiling and passive nocturnal fecal incontinence was reported by 2/37 patients. The neorectal compliance volume recovered from 12.5 ml kPa after subtotal colectomy and 11 ml/kPa at 6 months after INRA to a neorectal compliance of 24 ml/kPa at 2 years’ follow-up (p < 0.002; Wilcoxon signed rank test). Conclusion: The INRA procedure shows a low complication rate and reasonable functional results, there was however a considerable conversion rate in these first 53 cases and a high incidence of reclassification to CD.

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Section: Discussionmentioning

confidence: 99%

“…Fecundity in IPAA females has shown to be reduced to 54% as compared to ileo-rectal anastomosis (IRA) for FAP patients [8, 9, 10]. Obliteration of the pouch of Douglas is thought to be responsible for this.…”

Section: Introductionmentioning

confidence: 99%

Ileo-Neorectal Anastomosis: Medium- and Long-Term Follow-Up of 37 Patients

Laarhoven

Hueting²,

Schipper³

et al. 2004

Dig Surg

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“…Complications after RPC are common and morbidity rates are low, but not all surgeons obtain the same functional results with this procedure that also has consequences on female fertility (31) .…”

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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“…Studies reported that fertility was significantly reduced after IPAA compared to IRA in women with FAP (38). Therefore, in young women who wish to have children, an IPAA should be avoided or postponed if it is possible (31).…”

Section: Surgical Treatment In Hereditary Colon Cancer Syndromesmentioning

confidence: 99%

Recognition and management of hereditary colorectal cancer syndromes

Herraiz

Muñoz-Navas

2009

Rev. esp. enferm. dig.

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Over 1.900 colorectal tumors will arise in association with a hereditary colorectal cancer syndrome in Spain in 2009.The genetic defects responsible for the most common syndromes have been discovered in recent years.Genetic testing helps diagnose affected individuals and allows identification of individuals at-risk.Colonoscopy and prophylactic colectomy decrease colorectal cancer incidence and overall mortality in patients with hereditary colon cancer.Extracolonic tumors are frequent in these syndromes, so specific surveillance strategies should be offered.Key words: Familial adenomatous polyposis. Lynch syndrome. MYH-associated polyposis. Hereditary colon cancer. INTRODUCTIONIn 2009, it is estimated that around 38,000 people (1) in Spain will be diagnosed with colorectal cancer (CRC). Among these cases, more than 15% will exhibit familial clustering, and over 1,900 tumors (5%) will arise in association with a hereditary colorectal cancer syndrome. The most common hereditary colon cancer syndromes are: Familial Adenomatous Polyposis (FAP), attenuated FAP (AFAP), MYH associated polyposis (MAP), and Lynch syndrome, also known as Hereditary Non-Polyposis Colorectal Cancer syndrome (HNPCC) (2).During the last two decades, the most important advancement has been the identification of the genes that underlie these syndromes. This has permitted more accurate classifications of the various syndromes based upon genetic criteria, and consequently this has resulted in more tailored management strategies based on these criteria (3). The management of individuals with hereditary colon cancer or at-risk for hereditary colon cancer is dramatically different, so recognizing these syndromes is critical. Specifically, surveillance strategies for colon and extra-colonic tumors as well as surgical approaches (4) for the prevention and treatment of cancer reflect the heightened risks.This review is focused on current treatment strategies in hereditary colon cancer. It is important to recognize that "treatment" includes not only management of already diagnosed cancers but also to prevention of cancer in these high-risk populations. We first briefly summarize the major clinical features of each syndrome, including pattern of inheritance and penetrance, age at diagnosis and associated extra-colonic tumors. Familial adenomatous polyposis and attenuated FAPFAP is the most common adenomatous polyposis syndrome. Its prevalence is 1:5.000-10.000, with a uniform worldwide distribution, affecting both genders equally (5). Inherited in an autosomal dominant manner with a virtually penetrance of 100%, it is caused by a germline mutation in the Adenomatous Polyposis Coli (APC) tu- POINT OF VIEWmor suppressor gene on chromosome 5q21 (6). In 15-20%, the cases are "de novo" without clinical or genetic evidence of FAP in the parents (7). Recent studies indicate the presence of mosaicism in approximately 15% of such cases (8,9).Classic FAP is characterized by the development of hundreds to thousands of colorectal adenomas starting during the...

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Female fecundity before and after operation for familial adenomatous polyposis

Abstract: The significant reduction in female fecundity after ileal pouch-anal anastomosis should be communicated to young women with FAP before it is decided which surgical option to follow.

Cited by 243 publications

References 17 publications

Ileo-Neorectal Anastomosis: Medium- and Long-Term Follow-Up of 37 Patients

Ileo-Neorectal Anastomosis: Medium- and Long-Term Follow-Up of 37 Patients

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

Recognition and management of hereditary colorectal cancer syndromes

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