source: Diseases of the colon and rectum

year: 2014

authors: Church J M, Xhaja X, Warrier S K, Laguardia L, O'Malley M, Burke C, Kalady M F

BACKGROUND:
Elective proctocolectomy has been recommended for patients at high risk of desmoids based on the possibility that cancer in a retained rectum may be unresectable because of desmoid disease. There are no data to support the reality of this concern.

OBJECTIVE:
The aim of this study was to see how often proctectomy was prevented by desmoids.

DESIGN:
This retrospective, descriptive, database study was augmented by chart review.

SETTING:
This study was conducted at a hereditary colorectal cancer clinic in a tertiary referral center.

PATIENTS:
Those presenting for proctectomy after colectomy and ileorectal anastomosis for familial adenomatous polyposis were selected.

INTERVENTIONS:
Patients underwent a proctectomy.

MAIN OUTCOME MEASURES:
The primary outcomes measured were the rate of proctectomy, rate of IPAA, and the incidence of desmoid disease.

RESULTS:
Sixty- seven patients, 34 men and 33 women, underwent an operation with the intent of performing proctectomy. Mean age at surgery was 39.7 years, an average of 175 months from ileorectal anastomosis. Indications for proctectomy were uncontrollable adenomas in 56, cancer in 8, and high-grade dysplasia in 3. Proctectomy was always possible. Ileal pouch-anal anastomosis was planned in 62 patients; 54 had this operation. Desmoid disease was found in 26 patients (38.8%) and influenced surgery in 13 cases, stopping pouch-anal anastomosis in 8. One patient had no resection, 2 had a pouch-low rectal anastomosis, and 5 had proctectomy and ileostomy. Proctectomy and ileostomy was planned in 5 patients and performed in all.

LIMITATIONS:
This is a retrospective review from a single institution.

CONCLUSION:
The fear of an unresectable rectum or an impossible pouch-anal anastomosis should not be an indication for proctectomy in patients with low rectal polyp counts but a high risk for desmoid disease.