Long-Term Outcome of Metachronous Rectal Cancer Following Ileorectal Anastomosis for Familial Adenomatous Polyposis

Yamaguchi, Takashi; Yamamoto, Seiichiro; Fujita, Shin; Aoki, Takayuki; Moriya, Yoshihiro

doi:10.1007/s11605-009-1105-2

Cited by 12 publications

(10 citation statements)

References 23 publications

(31 reference statements)

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“…Therefore, the 33 % of other reasons as a cause of death does not reflect the morbidity of IRAoperated patients per se: instead it reflects the longer follow-up time. After the year 1991, there was no survival benefit found for IPAA-operated patients, which is an outcome that is in line with a previous study by Yamaguchi and colleagues, who found no survival difference in 96 patients who had either IPAA or IRA [6]. The improvement survival figures for IRA-operated patients during the IPAA era can be interpreted as being due to successful patient selection.…”

Section: Discussionsupporting

confidence: 88%

Comparison of proctocolectomy and ileal pouch-anal anastomosis to colectomy and ileorectal anastomosis in familial adenomatous polyposis

et al. 2014

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Prophylactic surgical options for familial adenomatous polyposis (FAP) are either colectomy and ileorectal anastomosis (IRA) or proctocolectomy and ileal pouch-anal anastomosis (IPAA). The aim of this study was to analyse the short-term and long-term outcomes of these two operative techniques. All patients with FAP in Finland have been prospectively recorded in a database since 1963 were retrospectively reviewed in this analysis. Altogether 140 (61%) colectomies with IRA and 88 (39%) proctocolectomies with IPAA have been performed. Complications occurred in 28 (21%) patients after IRA and in 26 (30%) patients after IPAA. There were 15 (11%) severe complications for IRA and 5 (6%) for IPAA. Twenty-one (15%) patients of the IRA group ended up in conventional ileostomy whereas 3 (3.4%) patients of the IPAA group had their ileal reservoir converted to an ileostomy (p = 0.01). Cumulative survival for IRA was lower than for the IPAA (p = 0.03), but if accounting only for operations made after the IPAA era had commenced, there was no significant difference. IPAA was associated with improved long-term survival without an increase in postoperative complications. The risk of death after colectomy and IRA seemed to be predominantly related to the remaining risk of rectal cancer. Therefore, we favour proctocolectomy with IPAA as the prophylactic surgical procedure for FAP with intermediate or severe polyposis.

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Section: Discussionsupporting

confidence: 88%

Comparison of proctocolectomy and ileal pouch-anal anastomosis to colectomy and ileorectal anastomosis in familial adenomatous polyposis

et al. 2014

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“…Advantages of ileorectal anastomosis emphasized by its advocates are debatable. Functional results and survival rate are nearly the same in patients 5 years after the mentioned procedure and ileal pouch-anal anastomosis [22]. Functioning of patients after restorative proctocolectomy assessed by the SF-36 questionnaire is comparable to that of not operated on [23].…”

Section: Discussionmentioning

confidence: 99%

The prognosis of clinical course and the analysis of the frequency of the inflammation and dysplasia in the intestinal J-pouch at the patients after restorative proctocolectomy due to FAP

Banasiewicz

Marciniak

Kaczmarek

et al. 2011

Int J Colorectal Dis

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PurposeThe main operative method in familial adenomatous polyposis (FAP) patients is restorative proctocolectomy with “J”-shaped pouch and temporary loop ileostomy. The aim of the study was the analysis of the frequency of the dysplasia and inflammation in the intestinal pouch and prognosis of the clinical course in FAP patients after restorative proctocolectomy.MethodsA group of 165 FAP patients (86 females and 79 males, mean age 22.49 ± 12) subjected to a restorative proctocolectomy in the years 1985–2009 was analyzed. Clinical data coming from follow-up observation in the period of 2004–2009 were evaluated. In all patients, clinical examination and endoscopy with polypectomy and/or biopsy of pouch mucosa were done.ResultsThe mean time of pouchitis occurrence after an ileal pouch-anal anastomosis was 6 months. Mean time for low-grade dysplasia was 14 months. The time difference of low-grade dysplasia after the above procedure as compared to pouchitis alone was substantial. Mean time for high-grade dysplasia was 16 months and for neoplasia even 19 months. It was estimated that early pouchitis happening within the first year after surgery occurs in 5% of patients, low-grade dysplasia 4 years later in 7% of cases, high-grade dysplasia 7 years later in around 10% of patients and neoplasia 14 years after surgery in 15% of cases.ConclusionsIn conclusion, the Polyposis Registry encompassing whole country is the best way of controlling FAP patients. The regular lifelong endoscopic monitoring gives the opportunity of the early detection of the dysplasia and can protect against neoplasia.

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“…The risk of rectal cancer and secondary proctectomy following rectum sparing surgery in familial adenomatous polyposis (FAP) depends on genotype and colorectal phenotype [1,2]. Following total colectomy with ileorectal anastomosis (TC-IRA), the cumulative risk of developing cancer in the residual rectum has been documented to be in the region of 10%-25% after 15-25 years and increasing to 29%-30% by the age of 60 years [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Regular endoscopic surveillance and polypectomy is effective in managing rectal adenoma progression following colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis

et al. 2021

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Aim: Total colectomy with ileorectal anastomosis (TC-IRA) is a surgical option for patients with familial adenomatous polyposis (FAP). Regular endoscopic surveillance of the rectum is recommended to prevent rectal cancer. We aimed to document polyp progression in the rectum following TC-IRA and evaluate the role of polypectomy during surveillance. Method:Patients with FAP who underwent TC-IRA between 1990 and 2017 were identified. Demographic, endoscopic and genetic data were retrieved. Cumulative rectal adenoma (polyp) counts were obtained, whilst accounting for any polypectomies during the study period. The rate of polyp progression and factors influencing secondary proctectomy were evaluated.Results: One hundred and ninety-nine patients fulfilled our inclusion criteria, of which 44% were male. The median age at colectomy was 19 (range 11-70) years and median preoperative rectal polyp count was 7 (range 0-50). All patients had an APC pathogenic variant, of which 151 (79%) were 5' of the mutation cluster region (MCR), 19 (10%) in the MCR, six (3%) were 3' of the MCR and 15 (8%) had a gross deletion. After a median followup of 8.6 (range1-27) years and a median of 11 (range 2-37) flexible sigmoidoscopies per patient, the median rate of polyp progression was 5.5 polyps/year (range 0-70.2). There was no evidence of polyp regression. Eight (4%) patients underwent secondary proctectomy for neoplasia, of which one (0.5%) had rectal adenocarcinoma. A total of 13,527 polyps were removed, a median of 35 polyps/patient (range 0-829). The rate of polyp progression was not significantly associated with genotypic or phenotypic factors. Conclusion:Progression of rectal adenoma burden following TC-IRA appears to be slow and dependent on the length of follow-up. In the modern era of stringent endoscopic surveillance and therapeutic procedures such as cold snare polypectomy, the rate of secondary proctectomy and the risk of rectal cancer after TC-IRA are very low. These findings are important when counselling patients with regard to the choice of surgery for FAP and implementing endoscopic surveillance.

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Long-Term Outcome of Metachronous Rectal Cancer Following Ileorectal Anastomosis for Familial Adenomatous Polyposis

Abstract: Effective IRA requires selection of patients without invasive rectal cancer and without dense rectal polyps in whom long-term postoperative follow-up of the residual rectum is possible.

Cited by 12 publications

References 23 publications

Comparison of proctocolectomy and ileal pouch-anal anastomosis to colectomy and ileorectal anastomosis in familial adenomatous polyposis

Comparison of proctocolectomy and ileal pouch-anal anastomosis to colectomy and ileorectal anastomosis in familial adenomatous polyposis

The prognosis of clinical course and the analysis of the frequency of the inflammation and dysplasia in the intestinal J-pouch at the patients after restorative proctocolectomy due to FAP

Regular endoscopic surveillance and polypectomy is effective in managing rectal adenoma progression following colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis

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