Abstract
Introduction
Neoplastic change in ileal reservoirs after proctocolectomy has been reported in patients with familial adenomatous polyposis. We aim to determine the incidence and progression of neoplastic change in the ileal pouch of familial adenomatous polyposis patients at our institution.
Methods
A retrospective review of all patients who underwent proctocolectomy for familial adenomatous polyposis with construction of an ileal pouch from 1972 to 2007 was performed. Data and status at follow-up were retrieved from the Mayo Clinic Colorectal Surgery Pouch database.
Results
One hundred seventeen patients were identified with a median age of 26, 52 were male. Ileal reservoirs included J-pouch (a = 104), Kock pouch (n = 9), S-pouch (n = 3), and W-pouch (n = 1). Median follow-up was 125 months. Polyps were biopsied in 33 patients: non-dysplastic polyps (n = 2), low-grade dysplasia (n = 30), and adenocarcinoma (n = 1). No patients had high-grade dysplasia. Median time to development of dysplasia was 149 months. Adenocarcinoma developed in one patient after 284 months. Risk of dysplasia at 10, 20, and 25 years was 17, 45, and 69 %, respectively.
Conclusion
Though there is a high incidence of low-grade dysplasia in the ileal reservoir in familial adenomatous polyposis patients, high-grade dysplasia and cancer occur rarely. Patients with low-grade dysplasia may still necessitate regular follow-up.
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References
Church J, Burke C, McGannon E, Pastean O, Clark B. Risk of rectal cancer in patients after colectomy and ileorectal anastomosis for familial adenomatous polyposis: a function of available surgical options. Dis Colon Rectum 2003; 46:1175–1181.
Vasen HF, van Duijvendijk P, Buskens E, Bülow C, Björk J, Järvinen HJ, Bülow S. Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients. Gut 2001; 49:231–235.
Nugent KP and RK Phillips. Rectal cancer risk in older patients with familial adenomatous polyposis and an ileorectal anastomosis: a cause for concern. Br J Surg 1992;79:1204–1206.
Bertario L, Presciuttini S, Sala P, Rossetti C, Pietroiusti M. Causes of death and postsurgical survival in familial adenomatous polyposis: results from the Italian Registry. Italian Registry of Familial Polyposis Writing Committee. Semin Surg Oncol 1994;10:225–234.
De Cosse JJ, Bulow S, Neale K, Järvinen H, Alm T, Hultcrantz R, Moesgaard F, Costello C. Rectal cancer risk in patients treated for familial adenomatous polyposis. The Leeds Castle Polyposis Group. Br J Surg 1992;79:1372–1375.
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;35:12–15.
Kartheuser AH, Parc R, Penna CP, Tiret E, Frileux P, Hannoun L, Nordlinger B, Loygue J. Ileal pouch-anal anastomosis as the first choice operation in patients with familial adenomatous polyposis: a ten-year experience. Surgery 1996;119:615–623.
Lal G. and S Gallinger. Familial adenomatous polyposis. Semin Surg Oncol 2000;18:314–323.
Wu JS, McGannon EA, Church JM. Incidence of neoplastic polyps in the ileal pouch of patients with familial adenomatous polyposis after restorative proctocolectomy. Dis Colon Rectum 1998;41:552–556; discussion 556–557.
Parc YR, Olschwang S, Desaint B, Schmitt G, Parc RG, Tiret E. Familial adenomatous polyposis: prevalence of adenomas in the ileal pouch after restorative proctocolectomy. Ann Surg 2001;233:360–364.
Polese L. and MR Keighley. Adenomas at resection margins do not influence the long-term development of pouch polyps after restorative proctocolectomy for familial adenomatous polyposis. Am J Surg 2003;186:32–34.
Iwama T, Mishima Y, Utsunomiya J. The impact of familial adenomatous polyposis on the tumorigenesis and mortality at the several organs. Its rational treatment. Ann Surg 1993;217:101–108.
Hoehner JC and AM Metcalf. Development of invasive adenocarcinoma following colectomy with ileoanal anastomosis for familial polyposis coli. Report of a case. Dis Colon Rectum 1994;37:824–828.
von Herbay A, Stern J, Herfarth C. Pouch-anal cancer after restorative proctocolectomy for familial adenomatous polyposis. Am J Surg Pathol 1996;20:995–999.
Bassuini MM and PJ Billings. Carcinoma in an ileoanal pouch after restorative proctocolectomy for familial adenomatous polyposis. Br J Surg 1996;83:506
Palkar VM, deSouza LJ, Jagannath P, Naresh KN. Adenocarcinoma arising in "J" pouch after total proctocolectomy for familial polyposis coli. Indian J Cancer 1997;34:16–19.
Cherki S, Glehen O, Moutardier V, François Y, Gilly FN, Vignal J. Pouch adenocarcinoma after restorative proctocolectomy for familial adenomatous polyposis. Colorectal Dis 2003;5:592–594.
Brown SR, Donati D, Seow-Choen F. Rectal cancer after mucosectomy for ileoanal pouch in familial adenomatous polyposis: report of a case. Dis Colon Rectum 2001;44:1714–1715.
Gullberg K, Lindforss U, Zetterquist H, Stålberg D, Reinholt FP, Veress B, Tribukait B, Olivecrona H, Löfberg R. Cancer risk assessment in long-standing pouchitis. DNA aberrations are rare in transformed neoplastic pelvic pouch mucosa. Int J Colorectal Dis 2002;17:92–97.
Gullberg K, Stahlberg D, Liljeqvist L, Tribukait B, Reinholt FP, Veress B, Löfberg R. Neoplastic transformation of the pelvic pouch mucosa in patients with ulcerative colitis. Gastroenterology 1997;112:1487–1492.
Veress B, Reinholt FP, Lindquist K, Löfberg R, Liljeqvist L. Long-term histomorphological surveillance of the pelvic ileal pouch: dysplasia develops in a subgroup of patients. Gastroenterology 1995;109:1090–1097.
Setti Carraro P, Talbot IC, Nicholls RJ. Longterm appraisal of the histological appearances of the ileal reservoir mucosa after restorative proctocolectomy for ulcerative colitis. Gut 1994;35:1721–1727.
Setti Carraro P, Talbot IC, Nicholls RJ. Recurrent, acute inflammatory changes and dysplasia in ileal reservoir epithelium. Dis Colon Rectum 1992;35:811.
Giebel GD and H Sabiers. Ileal pouch-anal anastomosis for ulcerative colitis and polyposis coli: is the risk of carcinoma formation conclusively averted? Eur J Surg Oncol 1996;22:372–376.
Thompson-Fawcett MW, Marcus VA, Redston M, Cohen Z, Mcleod RS. Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis. Dis Colon Rectum 2001;44:347–353.
Heuschen UA, Autschbach F, Allemeyer EH, Zöllinger AM, Heuschen G, Uehlein T, Herfarth C, Stern J. Long-term follow-up after ileoanal pouch procedure: algorithm for diagnosis, classification, and management of pouchitis. Dis Colon Rectum 2001;44:487–499.
Kuhbacher T, Schreiber S, Runkel N. Pouchitis: pathophysiology and treatment. Int J Colorectal Dis 1998;13:196–207.
Dozois RR, Kelly KA, Welling DR, Gordon H, Beart RW Jr, Wolff BG, Pemberton JH, Ilstrup DM. Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. Ann Surg 1989;210:268–271; discussion 272–263.
Tuckson W, Lavery I, Fazio V, Oakley J, Church J, Milsom J. Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation. Am J Surg 1991;161:90–95; discussion 95–96.
Church JM, Oakley JR, Wu JS. Pouch polyposis after ileal pouch-anal anastomosis for familial adenomatous polyposis: report of a case. Dis Colon Rectum 1996;39:584–586.
Remzi FH, Church JM, Bast J, Lavery IC, Strong SA, Hull TL, Harris GJ, Delaney CP, O'Riordain MG, McGannon EA, Fazio VW. Mucosectomy vs. stapled ileal pouch-anal anastomosis in patients with familial adenomatous polyposis: functional outcome and neoplasia control. Dis Colon Rectum 2001;44:1590–1596.
van Duijvendijk P, Vasen HF, Bertario L, Bülow S, Kuijpers JH, Schouten WR, Guillem JG, Taat CW, Slors JF. Cumulative risk of developing polyps or malignancy at the ileal pouch-anal anastomosis in patients with familial adenomatous polyposis. J Gastrointest Surg 1999;3:325–330.
Ziv Y, Fazio VW, Sirimarco MT, Lavery IC, Goldblum JR, Petras RE. Incidence, risk factors, and treatment of dysplasia in the anal transitional zone after ileal pouch-anal anastomosis. Dis Colon Rectum 1994;37:1281–1285.
Remzi FH, Fazio VW, Delaney CP, Preen M, Ormsby A, Bast J, O'Riordain MG, Strong SA, Church JM, Petras RE, Gramlich T, Lavery IC. Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years. Dis Colon Rectum 2003;46:6–13.
Vuilleumier H, Halkic N, Ksontini R, Gillet M. Columnar cuff cancer after restorative proctocolectomy for familial adenomatous polyposis. Gut 2000;47:732–734.
Ooi BS, Remzi FH, Gramlich T, Church JM, Preen M, Fazio VW. Anal transitional zone cancer after restorative proctocolectomy and ileoanal anastomosis in familial adenomatous polyposis: report of two cases. Dis Colon Rectum 2003;46:1418–1423; discussion 1422–1413.
Vrouenraets BC, Van Duijvendijk P, Bemelman WA, Offerhaus GJ, Slors JF. Adenocarcinoma in the anal canal after ileal pouch-anal anastomosis for familial adenomatous polyposis using a double-stapled technique: report of two cases. Dis Colon Rectum 2004;47:530–534.
O'Connell PR and N S Williams. Mucosectomy in restorative proctocolectomy. Br J Surg 1991;78:129–130.
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Boostrom, S.Y., Mathis, K.L., Pendlimari, R. et al. Risk of Neoplastic Change in Ileal Pouches in Familial Adenomatous Polyposis. J Gastrointest Surg 17, 1804–1808 (2013). https://doi.org/10.1007/s11605-013-2319-x
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DOI: https://doi.org/10.1007/s11605-013-2319-x