Skip to main content

Advertisement

SpringerLink
Log in

Feasibility of laparoscopic total proctocolectomy with ileal pouch–anal anastomosis and total colectomy with ileorectal anastomosis for familial adenomatous polyposis: results of a nationwide multicenter study

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

Data supporting the safety and feasibility of laparoscopic total proctocolectomy with ileal pouch–anal anastomosis (TPC-IPAA) and total colectomy with ileorectal anastomosis (TC-IRA) for patients with familial adenomatous polyposis (FAP) are limited. The aim of this study was to clarify the feasibility and morbidity of laparoscopic TPC-IPAA and TC-IRA for patients with FAP, using a large Japanese multicenter dataset.

Methods

Data on 256 patients with FAP who underwent TPC-IPAA (n = 171) or TC-IRA (n = 85) at 23 institutions between the years 2000 and 2012 were collected. Short- and long-term clinical outcomes were compared between laparoscopic and open approaches for each procedure.

Results

Among the 256 patients with FAP, a total of 126 patients underwent laparoscopic surgery, consisting of 74 laparoscopic TPC-IPAAs and 52 laparoscopic TC-IRAs. The proportion of the FAP patients who underwent laparoscopic surgery increased during the study period, reaching 79 % of all TPC-IPAAs and 82 % of all TC-IRAs in the final two years covered by the data. In both TPC-IPAA and TC-IRA, the laparoscopic approach was associated with a longer operative duration but a similarly low postoperative morbidity and comparably adequate anal function compared with the open approach. The overall survival and the incidence of desmoid tumor were also comparable between the laparoscopic and open approaches in both procedures.

Conclusions

Laparoscopic TPC-IPAA and TC-IRA are both feasible options—with low rates of morbidity, good functional outcomes, and excellent overall survival rates—in patients with FAP. Since the data indicate that laparoscopic TPC-IPAA and TC-IRA are feasible, they also support the recent increase in laparoscopic surgery for patients with FAP in Japan.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Casillas S, Delaney CP (2005) Laparoscopic surgery for inflammatory bowel disease. Dig Surg 22(3):135–142

    Article  PubMed  Google Scholar 

  2. Ky AJ, Sonoda T, Milsom JW (2002) One-stage laparoscopic restorative proctocolectomy: an alternative to the conventional approach? Dis Colon Rectum 45(2):207–210

    Article  PubMed  Google Scholar 

  3. Peters WR (1992) Laparoscopic total proctocolectomy with creation of ileostomy for ulcerative colitis: report of two cases. J Laparoendosc Surg 2(3):175–178

    Article  CAS  PubMed  Google Scholar 

  4. Santoro E, Carlini M, Carboni F et al (1999) Laparoscopic total proctocolectomy with ileal J pouch-anal anastomosis. Hepatogastroenterology 46(26):894–899

    CAS  PubMed  Google Scholar 

  5. Wexner SD, Johansen OB, Nogueras JJ et al (1992) Laparoscopic total abdominal colectomy. A prospective trial. Dis Colon Rectum 35(7):651–655

    Article  CAS  PubMed  Google Scholar 

  6. Ahmed Ali U, Keus F, Heikens JT et al (2009) Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev (1):CD006267

  7. Reissman P, Salky BA, Pfeifer J et al (1996) Laparoscopic surgery in the management of inflammatory bowel disease. Am J Surg 171(1):47–50

    Article  CAS  PubMed  Google Scholar 

  8. Sardinha TC, Wexner SD (1998) Laparoscopy for inflammatory bowel disease: pros and cons. World J Surg 22(4):370–374

    Article  CAS  PubMed  Google Scholar 

  9. Schmitt SL, Cohen SM, Wexner SD et al (1994) Does laparoscopic-assisted ileal pouch anal anastomosis reduce the length of hospitalization? Int J Colorectal Dis 9(3):134–137

    Article  CAS  PubMed  Google Scholar 

  10. Tilney HS, Lovegrove RE, Heriot AG et al (2007) Comparison of short-term outcomes of laparoscopic vs open approaches to ileal pouch surgery. Int J Colorectal Dis 22(5):531–542

    Article  PubMed  Google Scholar 

  11. Gill TS, Karantana A, Rees J et al (2004) Laparoscopic proctocolectomy with restorative ileal-anal pouch. Colorectal Dis 6(6):458–461

    Article  CAS  PubMed  Google Scholar 

  12. Larson DW, Cima RR, Dozois EJ et al (2006) Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg 243(5):667–670

    Article  PubMed  PubMed Central  Google Scholar 

  13. Marcello PW, Milsom JW, Wong SK et al (2000) Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 43(5):604–608

    Article  CAS  PubMed  Google Scholar 

  14. El-Gazzaz GS, Kiran RP, Remzi FH et al (2009) Outcomes for case-matched laparoscopically assisted versus open restorative proctocolectomy. Br J Surg 96(5):522–526

    Article  CAS  PubMed  Google Scholar 

  15. Heise CP, Kennedy G, Foley EF et al (2008) Laparoscopic restorative proctocolectomy with ileal S-pouch. Dis Colon Rectum 51(12):1790–1794

    Article  PubMed  Google Scholar 

  16. Polle SW, van Berge Henegouwen MI, Slors JF et al (2008) Total laparoscopic restorative proctocolectomy: are there advantages compared with the open and hand-assisted approaches? Dis Colon Rectum 51(5):541–548

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sylla P, Chessin DB, Gorfine SR et al (2009) Evaluation of one-stage laparoscopic-assisted restorative proctocolectomy at a specialty center: comparison with the open approach. Dis Colon Rectum 52(3):394–399

    Article  PubMed  Google Scholar 

  18. Zhang H, Hu S, Zhang G et al (2007) Laparoscopic versus open proctocolectomy with ileal pouch-anal anastomosis. Minim Invasive Ther Allied Technol 16(3):187–191

    Article  PubMed  Google Scholar 

  19. Ueno H, Kobayashi H, Konishi T et al (2016) Prevalence of laparoscopic surgical treatment and its clinical outcomes in patients with familial adenomatous polyposis in Japan. Int J Clin Oncol (in press)

  20. Konishi T, Watanabe T, Kishimoto J et al (2007) Prognosis and risk factors of metastasis in colorectal carcinoids: results of a nationwide registry over 15 years. Gut 56(6):863–868

    Article  PubMed  PubMed Central  Google Scholar 

  21. Konishi T, Watanabe T, Muto T et al (2006) Difference in incidence of colorectal cancer between men and women in Asia. Lancet Oncol 7(2):104–105

    Article  PubMed  Google Scholar 

  22. Ishida H, Iwama T, Tomita N et al (2014) Diagnosis and management of hereditary colorectal cancer according to the JSCCR Guidelines 2012 for the Clinical Practice of Hereditary Colorectal Cancer. Nihon Rinsho 72(1):143–149

    PubMed  Google Scholar 

  23. Watanabe T, Itabashi M, Shimada Y et al (2015) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 20(2):207–239

    Article  PubMed  PubMed Central  Google Scholar 

  24. Palanivelu C, Jani K, Sendhilkumar K et al (2008) Laparoscopic restorative total proctocolectomy with ileal pouch anal anastomosis for familial adenomatous polyposis. JSLS 12(3):256–261

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Chen KY, Xiang GA, Wang HN et al (2007) Total colectomy and proctocolectomy under laparoscopic for familial adenomatous polyposis. Zhonghua Yi Xue Za Zhi 87(13):913–915

    PubMed  Google Scholar 

  26. Milsom JW, Ludwig KA, Church JM et al (1997) Laparoscopic total abdominal colectomy with ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 40(6):675–678

    Article  CAS  PubMed  Google Scholar 

  27. Campos FG, Araujo SE, Melani AG et al (2011) Surgical outcomes of laparoscopic colorectal resections for familial adenomatous polyposis. Surg Laparosc Endosc Percutan Tech 21(5):327–333

    Article  PubMed  Google Scholar 

  28. Pokala N, Delaney CP, Senagore AJ et al (2005) Laparoscopic vs open total colectomy: a case-matched comparative study. Surg Endosc 19(4):531–535

    Article  CAS  PubMed  Google Scholar 

  29. Fazio VW, Kiran RP, Remzi FH et al (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257(4):679–685

    Article  PubMed  Google Scholar 

  30. de Zeeuw S, Ahmed Ali U, Donders RA et al (2012) Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Colorectal Dis 27(7):843–853

    Article  PubMed  PubMed Central  Google Scholar 

  31. Meagher AP, Farouk R, Dozois RR et al (1998) J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients. Br J Surg 85(6):800–803

    Article  CAS  PubMed  Google Scholar 

  32. Cohen G, Feder-Elituv R, Iazetta J et al (1998) Phase 2 studies of adenosine cardioplegia. Circulation 98(Suppl 19):II225–II233

  33. Laurent C, Leblanc F, Bretagnol F et al (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 95(7):903–908

    Article  CAS  PubMed  Google Scholar 

  34. Rosin D, Zmora O, Hoffman A et al (2007) Low incidence of adhesion-related bowel obstruction after laparoscopic colorectal surgery. J Laparoendosc Adv Surg Tech A 17(5):604–607

    Article  PubMed  Google Scholar 

  35. Hull TL, Joyce MR, Geisler DP et al (2012) Adhesions after laparoscopic and open ileal pouch-anal anastomosis surgery for ulcerative colitis. Br J Surg 99(2):270–275

    Article  CAS  PubMed  Google Scholar 

  36. Bartels SA, Vlug MS, Henneman D et al (2012) Less adhesiolysis and hernia repair during completion proctocolectomy after laparoscopic emergency colectomy for ulcerative colitis. Surg Endosc 26(2):368–373

    Article  PubMed  Google Scholar 

  37. Benlice C, Stocchi L, Costedio M et al (2015) Laparoscopic IPAA is not associated with decreased rates of incisional hernia and small-bowel obstruction when compared with open technique: long-term follow-up of a case-matched study. Dis Colon Rectum 58(3):314–320

    Article  PubMed  Google Scholar 

  38. Sinha A, Tekkis PP, Neale KF et al (2010) Risk factors predicting intra-abdominal desmoids in familial adenomatous polyposis: a single centre experience. Tech Coloproctol 14(2):141–146

    Article  CAS  PubMed  Google Scholar 

  39. Araki Y, Isomoto H, Tsuzi Y et al (1998) Clinical aspects of total colectomy—laparoscopic versus open technique for familial adenomatous polyposis and ulcerative colitis. Kurume Med J 45(2):203–207

  40. Kennedy GD, Heise C, Rajamanickam V et al (2009) Laparoscopy decreases postoperative complication rates after abdominal colectomy: results from the National Surgical Quality Improvement Program. Ann Surg 249(4):596–601

  41. Vitellaro M, Sala P, Signoroni S et al (2014) Risk of desmoid tumours after open and laparoscopic colectomy in patients with familial adenomatous polyposis. Br J Surg 101(5):558–565

    Article  CAS  PubMed  Google Scholar 

  42. Rodriguez-Bigas MA, Mahoney MC, Karakousis CP et al (1994) Desmoid tumors in patients with familial adenomatous polyposis. Cancer 74(4):1270–1274

    Article  CAS  PubMed  Google Scholar 

  43. Erkek AB, Church JM, Remzi FH (2007) Age-related analysis of functional outcome and quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis. J Gastroenterol Hepatol 22(5):710–714

    Article  PubMed  Google Scholar 

  44. Harnoy Y, Desfourneaux V, Bouguen G et al (2016) Sexuality and fertility outcomes after hand sewn versus stapled ileal pouch anal anastomosis for ulcerative colitis. J Surg Res 200(1):66–72

    Article  PubMed  Google Scholar 

  45. Kjaer MD, Laursen SB, Qvist N et al (2014) Sexual function and body image are similar after laparoscopy-assisted and open ileal pouch-anal anastomosis. World J Surg 38(9):2460–2465

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors acknowledge all the patients, their families, and the following investigators who participated in this study: Koji Komori, Department of Gastroenterological Surgery Aichi Cancer Center Hospital, Aichi; Kenjiro Kotake, Department of Surgery, Tochigi Cancer Center, Tochigi; Takeshi Nagasaka, Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Hirotoshi Hasegawa, Department of Surgery, Keio University School of Medicine, Tokyo; Motoi Koyama, Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori; Yoshito Akagi, Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka; Toshimasa Yatsuoka, Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama; Masataka Ikeda, Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka; Kensuke Kumamoto, Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima; Kiyotaka Kurachi, Department of Surgery 2, Hamamatsu University School of Medicine, Shizuoka; Kohji Tanakaya, Department of Surgery, Iwakuni Clinical Center, Yamaguchi; Kazuhiko Yoshimatsu, Department of Surgery, Tokyo Women’s Medical University Medical Center East, Tokyo.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Tsuyoshi Konishi

  2. Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan

    Tsuyoshi Konishi, Hideyuki Ishida, Hideki Ueno, Hirotoshi Kobayashi, Takao Hinoi, Yasuhiro Inoue, Fumio Ishida, Yukihide Kanemitsu, Tatsuro Yamaguchi, Naohiro Tomita, Nagahide Matsubara, Toshiaki Watanabe & Kenichi Sugihara

  3. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan

    Hideyuki Ishida

  4. Department of Surgery, National Defense Medical College, Saitama, Japan

    Hideki Ueno

  5. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Hirotoshi Kobayashi

  6. Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima, Japan

    Takao Hinoi

  7. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan

    Yasuhiro Inoue

  8. Digestive Disease Center, Northern Yokohama Hospital, Showa University, Yokohama, Japan

    Fumio Ishida

  9. Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan

    Yukihide Kanemitsu

  10. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Tatsuro Yamaguchi

  11. Department of Surgery, Hyogo College of Medicine, Hyogo, Japan

    Naohiro Tomita & Nagahide Matsubara

  12. Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Toshiaki Watanabe

  13. Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Tsuyoshi Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hideyuki Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideki Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hirotoshi Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takao Hinoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasuhiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fumio Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yukihide Kanemitsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tatsuro Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Naohiro Tomita
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nagahide Matsubara
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Toshiaki Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kenichi Sugihara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tsuyoshi Konishi.

Ethics declarations

Funding

The present study was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour and Welfare, and by the Japanese Society for Cancer of the Colon and Rectum.

Conflict of interest

Drs. Tsuyoshi Konishi, Hideyuki Ishida, Hideki Ueno, Hirotoshi Kobayashi, Takao Hinoi, Yasuhiro Inoue, Fumio Ishida, Yukihide Kanemitsu, Tatsuro Yamaguchi, Naohiro Tomita, Nagahide Matsubara, Toshiaki Watanabe, and Kenichi Sugihara have no conflict of interest or financial ties to disclose.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Konishi, T., Ishida, H., Ueno, H. et al. Feasibility of laparoscopic total proctocolectomy with ileal pouch–anal anastomosis and total colectomy with ileorectal anastomosis for familial adenomatous polyposis: results of a nationwide multicenter study. Int J Clin Oncol 21, 953–961 (2016). https://doi.org/10.1007/s10147-016-0977-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-016-0977-x

Keywords

Search

Navigation