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Long-Term Outcome of Metachronous Rectal Cancer Following Ileorectal Anastomosis for Familial Adenomatous Polyposis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Total colectomy with ileorectal anastomosis (IRA) for familial adenomatous polyposis (FAP) carries a potential risk of metachronous cancer in the residual rectum. This study evaluated the risk of cancer development in the residual rectum.

Methods

Ninety-six patients who underwent initial surgery for prevention and cure of FAP were studied, and a clinicopathologic comparison was conducted between 59 patients who underwent IRA and 24 who underwent total proctocolectomy.

Results

The 5-year overall survival rates were 94% after IRA and 95% after total proctocolectomy with no significant difference. The incidence of dense-type rectal polyps (4/17, 24%) was significantly higher in patients who developed metachronous rectal cancer following IRA compared to that in patients who did not (1/39, 3%). Moreover, 60% of patients with dense-type colon polyps developed metachronous rectal cancer compared to 24% in patients without and 80% of those with dense type rectal polyps developed metachronous rectal cancer compared to 25% without. Endoscopic surveillance of the eight Tis or T1 patients was performed at intervals of 6 months to 1 year after IRA but was not performed in three T3 patients for more than 2 years.

Conclusions

Effective IRA requires selection of patients without invasive rectal cancer and without dense rectal polyps in whom long-term postoperative follow-up of the residual rectum is possible.

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Authors and Affiliations

  1. Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Tomohiro Yamaguchi, Seiichiro Yamamoto, Shin Fujita, Takayuki Akasu & Yoshihiro Moriya

  2. Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan

    Tomohiro Yamaguchi

Authors
  1. Tomohiro Yamaguchi
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  2. Seiichiro Yamamoto
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  3. Shin Fujita
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  4. Takayuki Akasu
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  5. Yoshihiro Moriya
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Corresponding author

Correspondence to Seiichiro Yamamoto.

Additional information

A part of this paper was presented at the 2nd Biennial Scientific Meeting of International Society for Gastrointestinal Hereditary Tumors held between March 27 and 30, 2007 in Yokohama, Tokyo.

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Yamaguchi, T., Yamamoto, S., Fujita, S. et al. Long-Term Outcome of Metachronous Rectal Cancer Following Ileorectal Anastomosis for Familial Adenomatous Polyposis. J Gastrointest Surg 14, 500–505 (2010). https://doi.org/10.1007/s11605-009-1105-2

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  • DOI: https://doi.org/10.1007/s11605-009-1105-2

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