Prevalence and Management of Cancer of the Rectal Stump after Total Colectomy and Rectal Sparing in Patients with Familial Polyposis: Results from a Registry-Based Study

Abstract

Background: The balance between quality of life and colorectal cancer risk in familial adenomatous polyposis (FAP) patients is of primary importance. A cut-off of less than 30 polyps under 1 cm of diameter in the rectum has been used as an indication for performing ileo-rectal anastomosis (IRA) in terms of lower rectal cancer risk. This study aimed to assess clinical and surgical features of FAP patients who developed cancer of the rectal stump. Methods: This retrospective study included all FAP patients who underwent total colectomy/IRA from 1977 to 2021 and developed subsequent rectal cancer. Patients’ features were reported using descriptive statistics by considering the overall case series and within pre-specified classes of age (<20, 20–30, and >30 years) at first surgery. Results: Among the 715 FAP patients, 47 (6.57%, 95% confidence interval: 4.87; 8.65) developed cancer in the rectal stump during follow-up. In total, 57.45% of the population were male and 38.30% were proband. The median interval between surgery and the occurrence of rectal cancer was 13 years. This interval was wider in the youngest group (p-value: 0.012) than the oldest ones. Twelve patients (25.53%) received an endoscopic or minimally invasive resection. Amongst them, 61.70% were Dukes stage A cancers. Conclusions: There is a definite risk of rectal cancer after total colectomy/IRA; however, the time interval from the index procedure to cancer developing is long. Minimally invasive and endoscopic treatments should be the procedures of choice in patients with early stage cancers.

Reply to Serrano et al. Comment on “Colletti et al. Prevalence and Management of Cancer of the Rectal Stump after Total Colectomy and Rectal Sparing in Patients with Familial Polyposis: Results from a Registry-Based Study. Cancers 2022, 14, 298”

“…Moreov Serrano et al deem that 6.57% of patients developing rectal cancer following IRA is a ve good result compared to the literature. Our results are fully in line with those reported three studies [2,4,5], while they are quite a bit lower compared to Koskenvuo et al [3]. Reading the comment, we had the feeling that Serrano et al strongly seek a relation between genotype variant and surveillance following IRA.…”

“…Lastly, Serrano et al questioned that, despite strict endoscopic surveillance, the conservative treatment was feasible only in 25pts (53%). As we stated in the article [2], strict endoscopic surveillance allows detection of rectal cancer at an early stage in the majority of patients. However, we are analyzing the data of patients who have been treated over the last 45 years in a single center, and we undoubtedly need to consider some bias.…”

“…Years after colectomy, sex, proband/call-up status, familial/isolated case, colon cancer at IRA, or location of mutation did not show enough statistical significance [3]. Based on these data, the patients undergoing IRA at the National Cancer Institute of Milan are scheduled for an endoscopic surveillance every 6-12 months, as we mentioned in the article [2]. Lastly, Serrano et al questioned that, despite strict endoscopic surveillance, the conservative treatment was feasible only in 25pts (53%).…”

“…We carefully read the comment by Serrano et al [1] discussing the recent published article entitled "Prevalence and Management of Cancer of the Rectal Stump after Total Colectomy and Rectal Sparing in Patients with Familial Polyposis: Results from a Registry-Based Study" [2].…”

Comment on Colletti et al. Prevalence and Management of Cancer of the Rectal Stump after Total Colectomy and Rectal Sparing in Patients with Familial Polyposis: Results from a Registry-Based Study. Cancers 2022, 14, 298

“…We recently read the article by Colletti et al [ 1 ]; the large series of familial adenomatous polyposis (FAP) patients is impressive for a mono-institutional cohort. It is very important to develop an effective preventive strategy and to improve the management of rectal stump to reduce rectal cancer incidence and mortality after total colectomy with ileorectal anastomosis (IRA).…”