Risk of extracolonic malignancies and metachronous rectal cancer after colectomy and ileorectal anastomosis in familial adenomatous polyposis

Sasaki, Kazuhito; Nozawa, Hiroaki; Kawai, Kazushige; Murono, Koji; Emoto, Shigenobu; Kishikawa, Junko; Ishii, Hiroaki; Yokoyama, Yuichiro; Abe, Shinya; Nagai, Yoshinori; Anzai, Hiroyuki; Sonoda, Hirofumi; Taira, Tetsuro; Ishihara, Soichiro

doi:10.1016/j.asjsur.2021.06.034

Cited by 3 publications

(7 citation statements)

References 31 publications

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“…Moreover, the rate of metachronous rectal cancer development after stapled IPAA was similar to that after IRA, after a median surveillance period of approximately 19 years (10). Although studies have evaluated the incidence of metachronous rectal cancer (7,8), few have attempted to explore the long-term survival of patients with metachronous rectal cancer.…”

Section: Abstract Aim: To Evaluate the Risk Factors And Long-term Pro...mentioning

confidence: 88%

“…Although the choice of procedure is based on considerations such as expression type, number of polyps, quality of life, and fertility (4-6), this choice in prophylactic surgery determines the risk of subsequent carcinogenesis. IRA is known to cause metachronous rectal cancer in the remnant rectum (7,8). In a recent national cohort study in Finland, long-term surveillance over approximately 30 years after IRA revealed that 24% of patients developed metachronous rectal cancer (9).…”

Section: Abstract Aim: To Evaluate the Risk Factors And Long-term Pro...mentioning

confidence: 99%

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Long-term Prognostic Impact of Metachronous Rectal Cancer in Patients With Familial Adenomatous Polyposis: A Single-center Retrospective Study

Tatsuta

Sakata

Iwaizumi

et al. 2023

CDP

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Aim: To evaluate the risk factors and long-term prognosis of metachronous rectal cancer in the remnant rectum of patients with familial adenomatous polyposis (FAP). Patients and Methods: Sixty-five patients (49 families) who underwent prophylactic surgery, including bowel resection, for FAP between January 1976 and August 2022 at Hamamatsu University Hospital were included and divided into two groups based on the presence of metachronous rectal cancer. Risk factors for metachronous rectal cancer development were analysed in cases treated with total colectomy with ileorectal anastomosis (IRA) and stapled total proctocolectomy with ileal pouch anal anastomosis (IPAA) (IRA, n=22; stapled IPAA n=20; total, n=42). Results: The median surveillance period was 169 months. Twelve patients developed metachronous rectal cancer (IRA, n=5; stapled IPAA, n=7), of which six with advanced cancer died. Patients who temporarily dropped out of surveillance were significantly more likely to have metachronous rectal cancer (metachronous vs. non-metachronous rectal cancer: 33.3% vs. 1.9%, p<0.01). The mean duration of surveillance suspension was 87.8 months. Cox regression analysis revealed that temporary surveillance drop-out independently affected the risk (p=0.04). The overall survival associated with metachronous rectal cancer was 83.3% at 1 year and 41.7% at 5 years. Overall survival was significantly worse in advanced cancer than in early cancer cases (p<0.01). Conclusion: Temporary drop-out from surveillance was a risk factor for metachronous rectal cancer development, and advanced cancer had a poor prognosis. Continuous surveillance of patients with FAP, without temporary drop-out, is strongly recommended.

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Section: Abstract Aim: To Evaluate the Risk Factors And Long-term Pro...mentioning

confidence: 88%

Section: Abstract Aim: To Evaluate the Risk Factors And Long-term Pro...mentioning

confidence: 99%

Long-term Prognostic Impact of Metachronous Rectal Cancer in Patients With Familial Adenomatous Polyposis: A Single-center Retrospective Study

Tatsuta

Sakata

Iwaizumi

et al. 2023

CDP

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“…This is because the adenoma–carcinoma sequence after colectomy with IRA for FAP is similar to that of sporadic cancer. The cumulative risk of rectal cancer after IRA varies from 6% to 33% 75 , 77–81 , whereas the cumulative risk of dying from rectal cancer is between 9% and 12.5% 77–80 . Polyps in the rectal remnant can initially be treated endoscopically.…”

Section: Familial Adenomatous Polyposismentioning

confidence: 99%

“…Rates of up to 37% for rectal cancers and 50% for secondary proctectomies have been reported. This may have been due to patients’ desire to avoid a permanent ileostomy at a time when IPAA was not yet available 75 , 77 , 79 , 321–324 .…”

Section: Familial Adenomatous Polyposismentioning

confidence: 99%

“…The cumulative risk of rectal cancer after IRA varies from 6% to 33% 75 , 77–81 , whereas the cumulative risk of dying from rectal cancer is between 9% and 12.5% 77–80 . The risk factors for rectal cancer post IRA include a rectal polyp count >20 or a colonic polyp count of 500 or more prior to colectomy, an APC mutation at codons 1250–1450, and age <25 years at the time of surgery 55 .…”

Section: Familial Adenomatous Polyposismentioning

confidence: 99%

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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

Zaffaroni,

Mannucci,

Koskenvuo

et al. 2024

British Journal of Surgery

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Background Hereditary adenomatous polyposis syndromes, including familial adenomatous polyposis and other rare adenomatous polyposis syndromes, increase the lifetime risk of colorectal and other cancers. Methods A team of 38 experts convened to update the 2008 European recommendations for the clinical management of patients with adenomatous polyposis syndromes. Additionally, other rare monogenic adenomatous polyposis syndromes were reviewed and added. Eighty-nine clinically relevant questions were answered after a systematic review of the existing literature with grading of the evidence according to Grading of Recommendations, Assessment, Development, and Evaluation methodology. Two levels of consensus were identified: consensus threshold (≥67% of voting guideline committee members voting either ‘Strongly agree’ or ‘Agree’ during the Delphi rounds) and high threshold (consensus ≥ 80%). Results One hundred and forty statements reached a high level of consensus concerning the management of hereditary adenomatous polyposis syndromes. Conclusion These updated guidelines provide current, comprehensive, and evidence-based practical recommendations for the management of surveillance and treatment of familial adenomatous polyposis patients, encompassing additionally MUTYH-associated polyposis, gastric adenocarcinoma and proximal polyposis of the stomach and other recently identified polyposis syndromes based on pathogenic variants in other genes than APC or MUTYH. Due to the rarity of these diseases, patients should be managed at specialized centres.

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Long-term prognosis after stapled and hand-sewn ileal pouch–anal anastomoses for familial adenomatous polyposis: a multicenter retrospective study

Tatsuta,

Sakata,

Iwaizumi

et al. 2024

Int J Colorectal Dis

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Purpose The long-term prognosis of stapled and hand-sewn ileal pouch–anal anastomoses in familial adenomatous polyposis patients in Japan remains unknown. This study aimed to compare the overall survival in familial adenomatous polyposis patients who underwent stapled or hand-sewn ileal pouch–anal anastomosis. Methods This multicenter retrospective study was conducted at 12 institutions in Shizuoka Prefecture, Japan. The clinical outcomes of 53 eligible familial adenomatous polyposis patients who underwent stapled (n = 24) and hand-sewn (n = 29) ileal pouch–anal anastomosis were compared. Results The median follow-up duration was 171.5 months. The incidence of adenoma in the remnant rectum or anal transitional zone and metachronous rectal cancer was significantly more common in stapled ileal pouch–anal anastomosis (adenoma: stapled, 45.8%, vs. hand-sewn, 10.3%, p = 0.005; metachronous rectal cancer: 29.2%, vs. none, p = 0.002). The number of deaths was remarkably higher in stapled ileal pouch–anal anastomosis (p = 0.002). Metachronous rectal cancer was the most common cause of death. Overall survival was worse in stapled ileal pouch–anal anastomosis than in hand-sewn ileal pouch–anal anastomosis (120 months, 90.7% vs. 96.6%; 240 months, 63.7% vs. 96.6%; p = 0.044). Cox regression analysis revealed the independent effects of preoperative advanced colorectal cancer and stapled ileal pouch–anal anastomosis on overall survival. Conclusion Stapled ileal pouch–anal anastomosis negatively affected the overall survival of familial adenomatous polyposis patients. Therefore, hand-sewn ileal pouch–anal anastomosis is recommended for better prognosis in these patients.

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Risk of extracolonic malignancies and metachronous rectal cancer after colectomy and ileorectal anastomosis in familial adenomatous polyposis

Cited by 3 publications

References 31 publications

Long-term Prognostic Impact of Metachronous Rectal Cancer in Patients With Familial Adenomatous Polyposis: A Single-center Retrospective Study

Long-term Prognostic Impact of Metachronous Rectal Cancer in Patients With Familial Adenomatous Polyposis: A Single-center Retrospective Study

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

Long-term prognosis after stapled and hand-sewn ileal pouch–anal anastomoses for familial adenomatous polyposis: a multicenter retrospective study

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