| Theme | Polyposis of the colon and rectum, and other related conditions : hereditary colorectal cancer | |
|---|---|---|
| Title | Familial adenomatous polyposis -- surgical treatment | |
| Publish Date | 2005/11 | |
| Author | Motoi Koyama | Department of Surgery, Hirosaki University School of Medicine |
| Author | Takayuki Morita | Department of Surgery, Aomori Prefectural Central Hospital |
| Author | Akihiko Murata | Department of Surgery, Hirosaki University School of Medicine |
| Author | Yusuke Nishizawa | Department of Surgery, Hirosaki University School of Medicine |
| Author | Mutsuo Sasaki | Department of Surgery, Hirosaki University School of Medicine |
| [ Summary ] | Familial adenomatous polyposis (FAP) is an autosomal, dominantly inherited disease predisposing the patient to colorectal cancer. Surveillance of the pedigree and widespread use of prophylactic colectomy have resulted in a reduction in the incidence of colon cancer in FAP patients. The timing of surgery, and selection of surgical procedures, must be carefully decided on consideing the cancer risk to patients over their lifetime, while providing the best quality of life (QOL). During the 35 years from 1970 to 2005, we saw 73 patients with FAP in 16 families at Hirosaki University. In the 20-year period 1970-1990, 42 patients with FAP underwent surgery, of whom 29 were treated with total colectomy with ileo-rectal anastomosis (IRA) for patients with rectal sparse polyposis without cancer. The mean follow-up time after IRA was 19.7 years. Eight of the 29 (27.6 %) treated with IRA developed cancer in the residual rectum. Five of 8 developed advanced cancer, and 2 died of cancer of the residual rectum. These cases suggest that we should conduct restorative proctocolectomies with ileal J-pouch anal canal anastomosis (IACA) or ileal J-pouch anal anastomosis (IAA) for FAP patients, and should be careful to undertake lifelong surveillance. | |