Abstract
PURPOSE: This study was performed to determine the relationship among surgical treatment, colorectal cancer, and outcome in patients with familial adenomatous polyposis (FAP). METHODS: Records of 115 patients with FAP who underwent surgery at The Mount Sinai Medical Center between 1947 and 1994 were retrospectively reviewed. Patients without cancer were compared with those with colorectal cancer at initial surgery and with patients who developed rectal cancer following colectomy. RESULTS: Thirty-one patients (27 percent) had colorectal cancer at the time of initial surgery (colon=24; rectal=7). Another 11 patients (26 percent) developed rectal cancer after colectomy with ileorectal anastomosis (IRA). Mean age of patients with colorectal cancer at initial surgery was significantly higher than those without cancer (P <0.01). Patients who developed rectal cancer after IRA were significantly older than patients with colorectal cancer at initial surgery (P <0.01). All patients with rectal cancer after IRA had advanced disease with either nodal or distant metastases at the time of diagnosis. CONCLUSIONS: Colorectal cancer remains a major problem in the treatment of patients with FAP. Nearly one-fourth of these patients have colorectal cancer at initial operation, and one-fourth of patients with IRA develop rectal cancer after a mean follow-up of 13 years. Patients with rectal cancer following IRA are more likely to have advanced tumors than patients with colorectal cancer at initial operation. The high incidence and late stage of rectal cancer detected while under surveillance after IRA supports excision of the entire colorectal mucosa as the treatment of choice for most patients with FAP.
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References
Bulow S, Svendsen LB, Mellemgaard A. Metachronous colorectal carcinoma. Br J Surg 1990;77:502–5
Bussey HJ. Familial polyposis coli. Baltimore: Johns Hopkins University Press, 1975.
Sarre RG, Jagelman DG, Beck GJ,et al. Colectomy with ileorectal anastomosis for familial adenomatous polyposis: the risk of rectal cancer. Surgery 1987;101:20–6.
Phillips RK. Familial adenomatous polyposis: the surgical treatment of the colorectum. Semin Colon Rectal Surg 1995;6:33–7.
Jagelman DG. Choice of operation in familial adenomatous polyposis. World J Surg 1991;15:47–9.
Thomson JP. Familial adenomatous polyposis: the large bowel. Ann R Coll Surg Engl 1990;72:177–80.
Heimann TM, Gelernt I, Salky B, Bauer J, Greenstein A, Beck AR. Familial polyposis coli: results of mucosal proctectomy with ileoanal anastomosis. Dis Colon Rectum 1987;30:424–7.
Penna C, Tiret E, Daude F, Parc R. Results of ileal J-pouch-anal anastomosis in familial adenomatous polyposis complicated by rectal carcinoma. Dis Colon Rectum 1994;37:157–60.
Bulow S, Bulow C, Nielsen TF, Karlsen L, Moesgaard F. Centralized registration, prophylactic examination, and treatment results in improved prognosis in familial adenomatous polyposis: results from the Danish Polyposis Register. Scand J Gastroenterol 1995;30:989–93.
Petersen GM. Knowledge of the adenomatous polyposis coli gene and its clinical application. Ann Med 1994;26:205–8.
DeCosse JJ, Bulow S, Neale K,et al. Rectal cancer risk in patients treated for familial adenomatous polyposis: the Leeds Castle Polyposis Group. Br J Surg 1992;79:1372–5.
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 SM, Thomson JP. The rectum in adenomatous polyposis: the St. Mark's policy. Br J Surg 1985;72:S29–31.
Slors JF, den Hartog Jager FC, Trum JW, Taat CW, Brummelkamp WH. Long-term follow-up after colectomy and ileorectal anastomosis in familial adenomatous polyposis coli: is there still a place for the procedure? Hepatogastroenterology 1989;36:109–12.
Skinner MA, Tyler D, Branum GD, Cucchiaro G, Branum MA, Meyers WC. Subtotal colectomy for familial polyposis: a clinical series and review of the literature. Arch Surg 1990;125:621–4.
Heimann TM, Bolnick K, Aufses AH Jr. Results of surgical treatment for familial polyposis coli. Am J Surg 1986;152:276–8.
Gingold BS, Jagelman DG. Sparing the rectum in familial polyposis: causes for failure. Surgery 1981;89:314–8.
Nugent KP, Phillips RK. Rectal cancer risk in older patients with familial adenomatous polyposis and an ileorectal anastomosis: a cause for concern. Br J Surg 1992;79:1204–6.
Gurbuz AK, Giardiello FM, Petersen GM,et al. Desmoid tumours in familial adenomatous polyposis. Gut 1994;35:377–81.
Penna C, Kartheuser A, Parc R,et al. Secondary proctectomy and ileal pouch-anal anastomosis after ileorectal anastomosis for familial adenomatous polyposis. Br J Surg 1993;80:1621–3.
Everett WG, Forty J. The functional result of pelvic ileal reservoir in 10 patients with familial adenomatous polyposis. Ann R Coll Surg Engl 1989;71:28–30.
Ambroze WL Jr, Dozois RR, Pemberton JH, Beart RW Jr, Ilstrup DM. Familial adenomatous polyposis: results following ileal pouch-anal anastomosis and ileorectostomy. Dis Colon Rectum 1992;35:12–5.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996.
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Jang, Y.S., Steinhagen, R.M. & Heimann, T.M. Colorectal cancer in familial adenomatous polyposis. Dis Colon Rectum 40, 312–316 (1997). https://doi.org/10.1007/BF02050421
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DOI: https://doi.org/10.1007/BF02050421