Abstract
PURPOSE: Rectal cancer frequently occurs in patients with familial adenomatous polyposis (FAP) and, in some cases, proctocolectomy and ileal pouch-anal anastomosis (IPAA) can be proposed as an alternative to end ileostomy. This study aimed to assess the results of IPAA for familial adenomatous polyposis complicated by rectal carcinoma. PATIENTS AND METHODS: Postoperative morbidity and bowel function following IPAA were assessed in six patients who had a mesorectal excision for rectal cancer. The functional results were compared with those obtained after IPAA in 134 FAP patients without bowel cancer. RESULTS: Carcinomas were located at a mean of 11 cm from the dentate line. There were no postoperative complications. One patient with synchronous hepatic metastases died 6 months after operation and the 5 others were alive without recurrence after a mean follow-up of 29 months. Mean frequency of defecation was 6.5/day (vs. 4.2/day in patients without carcinoma), 86 percent of patients had nocturnal defecation (vs. 50 percent), day and night continence were normal in 66 percent and 33 percent of patients, respectively, compared with 90 percent and 85 percent for IPAA without cancer. Pouch excision was required in one patient for unsatisfactory functional result. CONCLUSION: IPAA can be safely performed for cancer of the upper rectum complicating FAP, but a poor functional outcome related to mesorectal excision has to be expected.
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References
Bussey HJ. Familial polyposis coli. London: John Hopkins University Press, 1975.
Wong WD, Rothenberger DA, Goldberg SM. Ileoanal pouch procedures. Curr Probl Surg 1985;22:1–78.
Nicholls J, Pescatori M, Motson RW, Pezim ME. Restorative proctocolectomy with a three-loop ileal reservoir for ulcerative colitis and familial adenomatous polyposis: clinical results in 66 patients followed for up to 6 years. Ann Surg 1984;199:383–8.
Stelzner M, Fonkalsrud EW. The endorectal ileal pullthrough procedure in patients with ulcerative colitis and familial polyposis with carcinoma. Surg Gynecol Obstet 1989;34:805–9.
Wiltz O, Hashmi HF, Shoetz DJ Jr,et al. Carcinoma and the ileal pouch-anal anastomosis. Dis Colon Rectum 1991;34:805–9.
Taylor BA, Wolff BG, Dozois RR, Kelly KA, Pemberton JH, Beart RW Jr. Ileal pouch-anal anastomosis for chronic ulcerative colitis and familial polyposis coli complicated by adenocarcinoma. Dis Colon Rectum 1988;31:358–62.
Hermanek P, Sobin LH, eds. Union Internationale Contre le Cancer. TNM classification of malignant tumors. 4th ed. Berlin: Springer-Verlag, 1987:197.
Jarvinen HJ. Time and type of prophylactic surgery for familial adenomatosis coli. Ann Surg 1985;202:93–7.
Penna C, Tiret E, Kartheuser A, Olschwang S, Parc R. Interet du depistage dans la prevention du cancer colorectal de la polypose adenomateuse familiale. Gastroenterol Clin Biol 1992;16:210–4.
Bess MA, Adson MA, Elveback LR, Moertel CG. Rectal cancer following colectomy for polyposis. Arch Surg 1980;115:460–7.
Bussey HJ, Eyers AA, Ritchie JM, Thomson JP. The rectum in adenomatous polyposis: the St. Mark's policy. Br J Surg 1985;72(Suppl):S29–31.
Pemberton JH, Phillips SF, Ready RR, Zinsmeister AR, Beahrs OH. Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status. Ann Surg 1989;209:620–8.
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Penna, C., Tiret, E., Daude, F. et al. Results of ileal J-pouch-anal anastomosis in familial adenomatous polyposis complicated by rectal carcinoma. Dis Colon Rectum 37, 157–160 (1994). https://doi.org/10.1007/BF02047539
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DOI: https://doi.org/10.1007/BF02047539