Impact of Surgery on the Development of Duodenal Cancer in Patients with Familial Adenomatous Polyposis

Abstract

Patients with familial adenomatous polyposis are at risk of significant neoplasia. The natural history of precancerous lesions might be related to surgical treatment of colorectal neoplasms.

Application of the Intramolecular Isomerisation–Aldolisation from Allylic Alcohols and Allylic Silyl Ethers to the Synthesis of Indanones and Indenones

“…All patients developed recurrent lesions by a mean of 13·3 months14. As other series15–18 have also described a high recurrence rate with this operation (80–100 per cent), it is of limited value as a prophylactic procedure.…”

“…It has the advantages of removing all duodenal mucosa while preserving the pancreaticobiliary anatomy, and rendering subsequent foregut endoscopic surveillance possible. Morbidity rates range from 30 to 63 per cent, with no deaths reported16–18, 26–31. The described incidence of metachronous jejunal polyps is low ( Table 2 ).…”

Updated European guidelines for clinical management of familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), gastric adenocarcinoma, proximal polyposis of the stomach (GAPPS) and other rare adenomatous polyposis syndromes: a joint EHTG-ESCP revision

“…However, the current Spigelman stage does not take this information into account 102 , 115 , 119 , 148 . Other concerns regarding the Spigelman stage include its application to the neo-duodenum after duodenal surgery 109 , its validity when chromoendoscopy significantly increases the duodenal polyp count and, consequently, the Spigelman stage 122 , 149 , and whether additional duodenal cancer risk factors should be included 104 , 116 , 121 , 127 .…”

“…During a median follow-up of 8.5 years, none of the duodenal adenomas under surveillance required treatment 118 , 151 . Stage IV duodenal polyposis has traditionally been treated with duodenal surgery, but patients may not develop cancer for several years and endoscopic downstaging can extend cancer-free surveillance (74% at 89 months) 98 , 108 , 116 , 119 . Duodenal surgery is associated with significant short-term mortality (about 5%) and morbidity (30–63%) 142 , 152–155 , so it should be offered to carefully selected patients 141 , 156 .…”

“…It is not uncommon for patients who undergo prophylactic duodenal surgery to have a duodenal cancer that was unsuspected before surgery 109 , 146 , 147 . Finally, the Spigelman stage only accounts for four risk factors 104 , 116 , 121 , 127 . There are additional duodenal cancer risk factors, including personal and family history of colorectal, duodenal and gastric cancer (see UGI.1).…”