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Different Surgical Strategies in the Treatment of Familial Adenomatous Polyposis: What’s the Role of the Ileorectal Anastomosis?

key information

source: Acta Gastro-Enterologica Belgica

year: 2011

authors: Wolthuis AM, Leonard D, Kartheuser A, Bruyninx L, Van De Stadt J, Van Cutsem E, D'Hoore A

summary/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.

organization: Belgian Familial Adenomatous Polyposis Association (FAPA)

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