Risk of Rectal Cancer in Patients After Colectomy and Ileorectal Anastomosis for Familial Adenomatous Polyposis

Church, James M.; Burke, Carol A.; McGannon, Ellen; Pastean, O.; Clark, Bryan

doi:10.1007/s10350-004-6710-2

Cited by 121 publications

(88 citation statements)

References 21 publications

(15 reference statements)

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“…The perception that IRA is a less technically demanding procedure than IPAA has in the past led to the suggestion that it is associated with less postoperative morbidity 47 . Factors that may play a part in this include increased operating time, hospital stay and blood loss with IPAA, as well as increased pelvic dissection and potential for damage to the internal anal sphincter 15 .…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of observational studies of ileorectal versus ileal pouch–anal anastomosis for familial adenomatous polyposis

Aziz

Athanasiou

Fazio

et al. 2006

British Journal of Surgery

171

121

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of observational studies of ileorectal versus ileal pouch–anal anastomosis for familial adenomatous polyposis

Aziz

Athanasiou

Fazio

et al. 2006

British Journal of Surgery

171

121

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“…Total abdominal colectomy with ileorectal anastomosis or total proctocolectomy with ileal pouch anal anastomosis are the traditional management strategies for colonic polyposis. Lifelong endoscopic surveillance of the rectum is required for the management of recurrent polyposis and does not obviate the development of uncontrolled rectal polyposis or rectal cancer that may require proctectomy (1).…”

Section: Introductionmentioning

confidence: 99%

A Phase Ib Study of the Effects of Black Raspberries on Rectal Polyps in Patients with Familial Adenomatous Polyposis

Wang¹,

Burke

Hasson

et al. 2014

Cancer Prevention Research

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Familial adenomatous polyposis (FAP) is characterized by the early onset of colonic polyposis and a high risk for colorectal cancer. FAP is treated by colectomy followed by lifelong removal of rectal polyps. This study determined whether black raspberries (BRBs) might regress rectal polyps in patients with FAP. Fourteen patients with FAP were treated with BRBs daily for 9 months. Seven patients received BRB powder orally plus two BRB suppositories inserted into the rectum at bedtime. The other 7 received an oral placebo plus the suppositories. Rectal polyp counts and polyp sizes were obtained at time zero and after 9 months of BRB treatment. Polyps and adjacent normal tissue were collected at both time points. The burden (P ¼ 0.036) but not number (P ¼ 0.069) of rectal polyps was significantly decreased. No benefit was noted with the addition of oral BRBs. Three patients were nonresponders. BRBs significantly decreased cellular proliferation, DNA methylation methyl transferase 1 protein expression, and p16 promoter methylation, but not promoter methylation of the Wnt pathway antagonists, SFRP2 and WIF1, in rectal polyps (adenomas) from responders but not from nonresponders. The MBD-seq assay revealed more demethylated transcription start sites (TSS), including those for miRNAs, in BRB-treated adenomas from the responders. In conclusion, BRB suppositories seem sufficient for regressing rectal polyps in patients with FAP. Cancer Prev Res; 7(7); 666-74. Ó2014 AACR.

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“…Ileorectal anastomosis should not be performed in severe diseases which have adenomas larger than 3 cm in diameter in the rectum, severe dysplasia, colonic or rectal cancer or sphincter dysfunction. It's better to perform IPAA in these cases (8). When polyposis becomes too significant not to be managed by polypectomy (i.e., when polyp ≥1 cm in diameter, polyp number >20 at any individual examination or with advanced histology is identified) proctocolectomy is recommended (9).…”

Section: Resultsmentioning

confidence: 99%

The Surgical Treatment Options for Familial Adenomatous Polyposis: A Clinic Experience

Tarcan¹,

Turanlı²,

Güler³

et al. 2016

Acta Oncol Tur.

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ÖZET Amaç: Ailesel adenomatöz polipoziste (AAP) cerrahi tedavi, abdominal kolektomi-ileorektal anastomoz (IRA), restoratif proktokolektomi-ileal J poş anal anastomoz (IPAA) ve total proktokolektomi-kalıcı ileostomiyi içerir. Bu çalışma ile hangi tip cerrahi yöntemin en iyi seçenek olduğu irdelendi. Gereç ve Yöntemler: Ailesel adenomatöz polipozis tanısıyla 2004-2014 yılları arasında aynı merkezde cerrahi girişim uygulanmış 20 hasta çalışmaya alındı. Hastalar uygulanan ameliyat türüne göre 3 gruba ayrıldı. Demografik özellikler, ameliyat bulguları, patoloji sonuçları ve klinik seyirlerine ilişkin veriler geriye dönük olarak hastane kayıtlarından elde edildi. Bulgular: Yirmi hastada AAP tanısı kolonoskopi ve patoloji raporuna dayanılarak konuldu. Bunların 15'inde kanser gelişmişken 5 hastada kolonoskopik taramada kanser henüz gelişmeden tanı konuldu. Kanser gelişen ve gelişmeyen hastaların ortanca yaşı sırasıyla 37 ve 20 yaş. Dört hastaya IPAA, 4 hastaya IRA ve geri kalan 12 hastaya total proktokolektomi kalıcı ileostomi uygulandı. Hastaların hepsinde 100 ve üzerinde kolonda polip vardı. Hastalar ortanca 38 aya takip edildi. Bu takip esnasında 8 hastada (%40.0) tekrarlayan veya metastatik hastalık gelişti. Bunlar; 4 hastada uzak metastaz, 3 hastada rektum kanseri (hepsine daha önce IRA yapılmış) ve bir hastada ise desmoid tümör şeklindeydi. Ayrıca IRA yapılmış 1 hastada rektumda adenom gelişti. Ileal poş adenomu ya da ileostomide adenom gelişimi izlenmedi. Dört hasta hastalığa bağlı kaybedildi. Bunlardan 3'ü metastatik hastalık gelişimine bağlıyken kalan 1 hastada dev desmoid tümörün neden olduğu böbrek yetmezliği ölüm sebebiydi. Sonuç: Ameliyat öncesi kanser tanısı konulmuş klasik AAP hastalarında cerrahi yöntem olarak abdominal kolektomi-IRA seçimi iyi bir seçenek olmayabilir. Ancak çalışmanın az sayıda hastayı kapsadığı da göz önünde bulundurulmalıdır. Anahtar Kelimeler: Ailesel adenomatöz polipozis, kolektomi, proktokolektomi, karsinom ABSTRACT Objective: Familial adenomatous polyposis (FAP) is treated by abdominal colectomy with ileorectal anastomosis (IRA), restorative proctocolectomy with ileal J-pouch anal anastomosis (IPAA), and total proctocolectomy with ileostomy. This study investigated question is what type of surgery is better. Material and Method: Twenty FAP patients, who underwent surgery in a single hospital between 2004 and 2014, were included. Patients were classified in 3 groups according to the operation procedures. Demographic, surgical, pathological, and outcome data were analyzed from hospital records retrospectively. Results: Overall 20 patients were included, 15 index patients, and 5 relatives diagnosed by screening. Median age of patients with or without colorectal cancer was 37 and 20 years respectively. Four patients were treated by IPAA, 4 by IRA, and 12 by proctocolectomy. All patients presented with 100 or more colonic polyps. The median follow-up time was 38 months. During the follow-up period, 8 (40.0%) patients developed recurrent or metastatic disease. There were; distant metast...

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Risk of Rectal Cancer in Patients After Colectomy and Ileorectal Anastomosis for Familial Adenomatous Polyposis

Cited by 121 publications

References 21 publications

Meta-analysis of observational studies of ileorectal versus ileal pouch–anal anastomosis for familial adenomatous polyposis

Meta-analysis of observational studies of ileorectal versus ileal pouch–anal anastomosis for familial adenomatous polyposis

A Phase Ib Study of the Effects of Black Raspberries on Rectal Polyps in Patients with Familial Adenomatous Polyposis

The Surgical Treatment Options for Familial Adenomatous Polyposis: A Clinic Experience

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