Abstract
Rectal polyp regression has been observed in familial adenomatous polyposis (FAP) after colectomy and ileorectal anastomosis (IRA). In view of the association between risk of neoplasia and epithelial cell turnover rates, a study was conducted to determine the effect of colectomy and IRA on rectal mucosal proliferation in FAP. Endoscopic biopsies of flat rectal mucosa were taken from 12 FAP patients with an established IRA and 10 FAP patients prior to colectomy. Mucosal proliferation was assessed by flash-labeling S-phase cells with bromodeoxyuridine. Labeled cells were visualized on paraffin sections with an immunohistochemical stain using a monoclonal antibody to bromodeoxyuridine. Twenty crypt columns were analyzed. The mean labeling index (percent labeled cells/crypt) of the FAP patients with established IRAs (7.0±1.4 percent) was significantly less than that of the precolectomy patients (12.8±3.0 percent) (Mann-Whitney U test,P =0.0004). Comparison of labeled distribution curves shows a contraction of the crypt proliferative zone in the IRA group. Colectomy with IRA in FAP is associated with a significant reduction in rectal mucosal cell proliferation. These findings support the claim of reduced risk of rectal cancer following this procedure in FAP and are of relevance to the study of environmental vs.genetic control of cell proliferation.
Similar content being viewed by others
References
Bussey HJ, Eyers AA, Ritchie SM, Thomson JP. The rectum in adenomatous polyposis: the St. Mark's policy. Br J Surg 1985;72(Suppl):S29-S35.
Sarre RG, Jagelman DG, Beck GJ,et al. Colectomy with ileorectal anastomosis for familial adenomatous polyposis. Surgery 1987;101:20–6.
Madden MV, Neale KF, Nicholls RJ,et al. A comparison of morbidity and function after colectomy with ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis. Br J Surg 1991;78:789–92.
Nicholls RJ, Springall RG, Gallagher P. Regression of rectal adenomas after colectomy and ileorectal anastomosis for familial adenomatous polyposis. BMJ 1988;296:1707–8.
Shepherd JA. Familial polyposis of the colon with special reference to regression of rectal polyposis after subtotal colectomy. Br J Surg 1971;58:85–91.
Lipkin M, Blattner WE, Fraumeni JF, Lynch HT, Deschner E, Winawer S. Tritiated thymidine labeling distribution as a marker for hereditary predisposition to colon cancer. Cancer Res 1983;43:1899–904.
Wilson RG, Smith AN, Bird CC. Immunohistochemical detection of abnormal cell proliferation in colonic mucosa of subjects with polyps. J Clin Pathol 1990;43:744–7.
Goodlad RA, Wright NA. Quantitative studies on epithelial replacement in the gut. In: Titchen DA, ed. Techniques in digestive physiology. Amsterdam: Elsevier Scientific Publications, 1982:1–23.
Thornton JG, Wells M, Hume WJ. Flash labelling of S-phase cells in short-term organ culture of normal and pathological human endometrium using bromodeoxyuridine and tritiated thymidine. J Pathol 1988;154:321–8.
Wright NW, Alison M. The biology of epithelial cell populations. Vols. 1 and 2. Oxford: Clarendon Press, 1984.
Hill MJ, Draser BS, Aries VC, Crowther JS, Hawksworth GM, Williams RE. Bacteria and the aetiology of large bowel cancer. Lancet 1971;1:95–100.
Reddy BS, Narasawa T, Weisburger JH, Wynder EL. Promoting effect of sodium deoxycholate on colon adenocarcinomas in germfree rats. J Natl Cancer Inst 1976;56:441–8.
Ryan GP, Dudrick AJ, Copeland EM, Johnson LR. Effect of various diets on colonic growth in rats. Gastroenterology 1979;77:658–63.
Bristol JB, Williamson RC. Large bowel growth. Scand J Gastroenterol 1984;93(Suppl):25–34.
Owen WJ, Lyttle JA. Rectal adaption to colectomy and ileorectal anastomosis in the rat. Gut 1979;20:444–6.
Goodlad RA, Wilson TJ, Lenton W, Gregory H, McCullagh KG, Wright NA. Proliferative effects of urogastrone-EGF on the intestinal epithelium. Gut 1987;28(Suppl 1):37–43.
Author information
Authors and Affiliations
Additional information
Dr. Farmer was supported by the St. Mark's Research Foundation.
About this article
Cite this article
Farmer, K.C.R., Phillips, R.K.S. Colectomy with ileorectal anastomosis lowers rectal mucosal cell proliferation in familial adenomatous polyposis. Dis Colon Rectum 36, 167–171 (1993). https://doi.org/10.1007/BF02051173
Issue Date:
DOI: https://doi.org/10.1007/BF02051173