Different surgical strategies in the treatment of familial adenomatous polyposis : what's the role of the ileorectal anastomosis?
(2011) Acta Gastro-Enterologica Belgica (Multilingual Edition) — Vol. 74, n° 3, p. 435-437 (2011)
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- Abstract
- Prophylactic (procto-) colectomy is the treatment of choice to reduce the risk of colorectal cancer in FAP patients with multiple adenomas. Because patients present at young age, rectum-sparing surgery is sometimes advocated, so that there is no pelvic dissection with impact on quality of life, preserved pelvic innervation and sexual function and fertility. The main disadvantage of a total colectomy with an ileorectal anastomosis (IRA) is a rectal cancer risk of 50% at the age of 50 years and a cumulative risk of 25.8% after 25 years of follow-up. Therefore, this procedure should be reserved for patients with an unaffected rectum. There should be no discussion to perform a primary IPAA in patients with multiple rectal adenomas (> 20) or those with a severe dysplastic or large (> 3 cm) rectal adenoma or a cancer elsewhere in the colon. A patient with an IRA should undergo yearly follow-up by rectoscopy.
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Citations
Wolthuis, A. M., Leonard, D., Kartheuser, A., Bruyninx, L., Van De Stadt, J., Van Cutsem, E., & D’Hoore, A. (2011). Different surgical strategies in the treatment of familial adenomatous polyposis : what’s the role of the ileorectal anastomosis? Acta Gastro-Enterologica Belgica (Multilingual Edition), 74(3), 435-437. https://hdl.handle.net/2078.5/163288 (Original work published 2011)