Abstract
PURPOSE: One of the concerns with colectomy and ileorectal anastomosis as a prophylactic procedure for patients with familial adenomatous polyposis is the risk of metachronous rectal cancer, estimated at from 12 to 43 percent. These estimates are based largely on surgeries performed at a time when the only alternative option to ileorectal anastomosis for patients with severe familial adenomatous polyposis was proctocolectomy and ileostomy. This study was designed to test the hypothesis that in the pouch era severe polyposis is now treated by proctocolectomy and ileal pouch-anal anastomosis. Ileorectal anastomosis is performed mostly in mildly affected patients and will therefore carry a very low risk of metachronous rectal cancer. METHODS: Patients undergoing primary prophylactic surgery for familial adenomatous polyposis between 1950 and 1999 were categorized according to the year of their surgery: prepouch era (before 1983) or pouch era (after 1983). Patients undergoing colectomy and ileorectal anastomosis were the focus of the study, and rate of proctectomy and the incidence of rectal cancer were recorded for each group. Data on the severity of the polyposis for each group were abstracted. RESULTS: A total of 197 patients underwent ileorectal anastomosis, 62 in the prepouch era (median follow-up, 212 months; interquartile range, 148 months) and 135 in the pouch era (median follow-up, 60 months; interquartile range, 80 months). Patients in the prepouch era came to surgery at the same median age as those in the pouch era (median age 23.0 years, interquartile ranges 15.5 years for prepouch and 17 years for pouch). Similar proportions of patients in the prepouch era had severe polyposis (49 percent) as in the pouch era (44 percent), although all severely affected patients had an ileorectal anastomosis in the prepouch era vs. 39 percent in the pouch era. Twenty (32 percent) prepouch-era patients underwent proctectomy compared with three (2 percent) pouch-era patients. No pouch-era patient had rectal cancer on follow-up; eight (12.9 percent) prepouch-era patients did. CONCLUSION: Although follow-up is shorter, ileorectal anastomosis for familial adenomatous polyposis performed since 1983 carries a much lower rate of rectal cancer and proctectomy than ileorectal anastomosis performed before this time, when restorative proctocolectomy was not an option. This is related, at least in part, to a greater number of patients with severe polyposis having their rectum initially spared.
Similar content being viewed by others
References
C Soravia L Klein T Berk BI O’Connor Z Cohen RS McLeod (1999) ArticleTitleComparison of ileal pouch-anal anastomosis and ileorectal anastomosis in patients with familial adenomatous polyposis Dis Colon Rectum 42 1028–1034
I Heiskanen HJ Jarvinen (1997) ArticleTitleFate of the rectal stump after colectomy and ileorectal anastomosis for familial adenomatous polyposis Int J Colorectal Dis 12 9–13
WL Ambroze SuffixJr RR Dozois JH Pemberton RW Beart SuffixJr DM Ilstrup (1992) ArticleTitleFamilial adenomatous polyposis Dis Colon Rectum 35 12–15
L Bertario A Russo P Radice et al. (2000) ArticleTitleGenotype and phenotype factors as determinants for rectal stump cancer in patients with familial adenomatous polyposis Ann Surg 231 538–543
JS Wu P Paul EA McGannon JM Church (1998) ArticleTitleAPC genotype, polyp number and surgical options in familial adenomatous polyposis Ann Surg 227 57–62
HS Debinski S Love AD Spigelman RK Phillips (1996) ArticleTitleColorectal polyp counts and cancer risk in familial adenomatous polyposis Gastroenterology 110 1028–1030
KP Nugent RK Phillips (1992) ArticleTitleRectal cancer risk in older patients with familial adenomatous polyposis and an ileorectal anastomosis Br J Surg 79 1204–1206
F Tonelli R Valanzano I Monaci P Mazzoni A Anasti F Ficari (1997) ArticleTitleRestorative proctocolectomy or rectum-preserving surgery in patients with familial adenomatous polyposis World J Surg 21 653–658
JF Slors FC den Hartog Jager JW Trum CW Taat WH Brummelkamp (1989) ArticleTitleLong-term follow-up after colectomy and ileorectal anastomosis in familial adenomatous polyposis coli. Is there still a place for the procedure? Hepatogastroenterology 36 109–112
MA Skinner D Tyler GD Branum G Cucchiaro MA Branum WC Meyers (1990) ArticleTitleSubtotal colectomy for familial polyposis. A clinical series and review of the literature Arch Surg 125 621–624
TM Heimann K Bolick AH Aufses (1986) ArticleTitleResults of surgical treatment for familial polyposis coli Am J Surg 152 276–278
JJ De Cosse S Bulow K Neale et al. (1992) ArticleTitleRectal cancer risk in patients treated for familial adenomatous polyposis. The Leeds Castle Polyposis Group Br J Surg 79 1372–1375
RG Sarre DG Jagelman AJ Beck et al. (1987) ArticleTitleColectomy with ileorectal anastomosis for familial adenomatous polyposis Surgery 101 20–25
JC Harvey SH Quan M Stearns (1978) ArticleTitleManagement of familial polyposis with preservation of the rectum Surgery 84 476–482
J Svab M Peskova V Jirasek M Fried Z Krska (1999) ArticleTitleLong-term results of ileo-rectal anastomosis in familial polyposis [in Czech] Rozhledy V Chirugii 78 150–153
MA Bess MA Adson LR Elveback CG Moertel (1980) ArticleTitleRectal cancer following colectomy for polyposis Arch Surg 121 460–467
S Bulow (1984) ArticleTitleThe risk of developing rectal cancer after colectomy and ileorectal anastomosis in Danish patients with polyposis coli Dis Colon Rectum 27 726–729
DC Jenner S Levitt (1998) ArticleTitleRectal cancer following colectomy and ileorectal anastomosis for familial adenomatous polyposis Aust N Z J Surg 68 136–138
HJ Jarvinen (1985) ArticleTitleTime and type of prophylactic surgery for familial adenomatous coli Ann Surg 202 93–97
AL Watne JM Carrier JP Durham EE Hrabovsky W Chang (1983) ArticleTitleThe occurrence of carcinoma of the rectum following ileoproctostomy for familial polyposis Ann Surg 197 550–553
T Iwama Y Mishima J Utsinomiya (1993) ArticleTitleThe impact of familial adenomatous polyposis on the tumorigenesis and mortality at the several organs. Its rational treatment Ann Surg 217 101–108
C Bulow H Vasen H Jarvinen et al. (2000) ArticleTitleIleorectal anastomosis is appropriate for a subset of patients with familial adenomatous polyposis Gastroenterology 119 1454–1460
J Church C Burke E McGannon O Pastean B Clark (2001) ArticleTitlePredicting polyposis severity by proctoscopy; how reliable is it? Dis Colon Rectum 44 1249–1254
HF Vasen RB van der Luijt JF Slors et al. (1996) ArticleTitleMolecular genetic tests as a guide to surgical management of familial adenomatous polyposis Lancet 348 433–435
BS Gingold DG Jagelman (1981) ArticleTitleSparing the rectum in familial polyposis Surgery 89 314–318
SM Feinberg DG Jagelman RG Sarre et al. (1988) ArticleTitleSpontaneous resolution of rectal polyps in patients with familial polyposis following abdominal colectomy and ileorectal anastomosis Dis Colon Rectum 31 169–175
Author information
Authors and Affiliations
About this article
Cite this article
Church, J., Burke, C., McGannon, E. et al. Risk of Rectal Cancer in Patients After Colectomy and Ileorectal Anastomosis for Familial Adenomatous Polyposis. Dis Colon Rectum 46, 1175–1181 (2003). https://doi.org/10.1007/s10350-004-6710-2
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-6710-2