Mucosectomy with Handsewn Anastomosis Reduces the Risk of Adenoma Formation in the Anorectal Segment After Restorative Proctocolectomy for Familial Adenomatous Polyposis | oneFAPvoice

welcome to oneFAPvoice

- a positively charged Familial Adenomatous Polyposis community.
  • join today!
scientific articles

Mucosectomy with Handsewn Anastomosis Reduces the Risk of Adenoma Formation in the Anorectal Segment After Restorative Proctocolectomy for Familial Adenomatous Polyposis

key information

source: Annals of surgery

year: 2011

authors: Alexander C. von Roon, Olivia C. C. Will, Ripple F. Man, Kay F. Neale, John R. Nicholls, Susan K. Clark, Robin K. S. Phillips, Paris P. Tekkis

summary/abstract:

OBJECTIVE : The study compared the risk of adenoma or carcinoma formation in the anorectal segment after either mucosectomy with manual anastomosis or stapled ileoanal anastomosis (IAA) following restorative proctocolectomy (RPC) for familial adenomatous polyposis (FAP).

BACKGROUND : Few data exist on the risk of adenoma formation after either technique in FAP.

METHODS : All endoscopy and histology reports for patients having RPC for FAP attending for annual pouchoscopy from 1978 to 2007 were reviewed. The incidence, timing, and histological characteristics of adenoma or carcinoma formation were recorded.

RESULTS : Of the 206 patients, 140 attended for endoscopic follow-up for a median of 10.3 years after RPC. Fifty-two patients developed neoplastic transformation in the anorectal segment, with a cumulative risk at 10 years of 22.6% after mucosectomy with manual anastomosis and 51.1% after stapled IAA (P < 0.001). The median time to first adenoma was longer after mucosectomy with handsewn anastomosis than after stapled IAA (10.1 vs 6.5 years, P < 0.001). On multivariate analysis, stapled IAA (hazard ratio= 3.45, 95% confidence interval = 1.01–4.98) and age at RPC older than 40 years (hazard ratio = 2.20, 95% confidence interval = 1.01–4.89) were significantly associated with increased risk of adenoma formation. Nine patients developed a large (>10 mm) adenoma. One patient (handsewn ileoanal anastomosis) developed adenocarcinoma in the anorectal mucosa at 13 years and required pouch excision.

CONCLUSIONS : Adenoma formation in the anorectal mucosa after RPC for FAP is common but carcinoma is rare. The risk is lower after mucosectomy with handsewn anastomosis than after stapled IAA. Regular endoscopic surveillance after either technique is mandatory.

organization: St Mark’s Hospital London

DOI: 10.1097/SLA.0b013e318f3f498

read more

expertly curated content related to this topic

To improve your experience on this site, we use cookies. This includes cookies essential for the basic functioning of our website, cookies for analytics purposes, and cookies enabling us to personalize site content. By clicking on 'Accept' or any content on this site, you agree that cookies can be placed. You may adjust your browser's cookie settings to suit your preferences.
More information

The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.

Close