Different surgical strategies in the treatment of familial adenomatous polyposis : what's the role of the ileorectal anastomosis ?
| Journal | Volume 74 - 2011 |
| Issue | Fasc.3 - Symposium |
| Author(s) | Albert M. Wolthuis, Daniel Leonard, Alex Kartheuser, Luc Bruyninx, Jean Van De Stadt, Eric Van Cutsem, André D'Hoore |
| Full article |
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| (1) Belgian Polyposis Project, Familial Adenomatous Polyposis Association (FAPA), Brussels ; (2) Board Member of the FAPA, Department of Abdominal Surgery, University Hospital Leuven, Leuven ; (3) Board Member of the FAPA, Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires St-Luc, Brussels ; (4) General Secretary of the FAPA, Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires St-Luc, Brussel ; (5) Board Member of the FAPA, Service de Chirurgie digestive, coelioscopique et thoracique, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Brussels ; (6) Board Member of the FAPA, Clinic of Colorectal Surgery, Department of Digestive Surgery, Hôpital Erasme, Brussels ; (7) President of the FAPA, Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven. |
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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 recto- scopy. (Acta gastroenterol. belg., 2011, 74, 435-437). |
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© Acta Gastro-Enterologica Belgica. PMID 22103050 |
