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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 12/2006

01-12-2006

Impact of Surgery on the Development of Duodenal Cancer in Patients with Familial Adenomatous Polyposis

Authors: G. Biasco, M.D., E. Nobili, M.D., C. Calabrese, M.D., Ph.D., R. Sassatelli, M.D., L. Camellini, M.D., M. A. Pantaleo, M.D., Ph.D., G. Bertoni, M.D., A. De Vivo, M.D., M. Ponz De Leon, M.D., G. Poggioli, M.D., G. Bedogni, M.D., T. Venesio, Ph.D., L. Varesco, M.D., M. Risio, M.D., G. Di Febo, M.D., G. Brandi, M.D.

Published in: Diseases of the Colon & Rectum | Issue 12/2006

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Purpose

Precancerous duodenal lesions in patients with familial adenomatous polyposis can be detected with duodenoscopy and treatment may prevent the development of cancer. We proposed to determine the frequency, natural history, cumulative risk, and risk factors of the precancerous duodenal lesions in a series of patients diagnosed in northern Italy.

Methods

A prospective, endoscopic, follow-up protocol was performed in 50 patients examined by gastroduodenoscopy at two years of interval or less. The presence and severity of precancerous lesions of the duodenal mucosa were evaluated by Spigelman score. Twenty-five patients (50 percent) had proctocolectomy and ileoanal anastomosis, 15 (30 percent) had colectomy and ileorectal anastomosis, and 5 (10 percent) had proctocolectomy and definitive ileostomy from 0 to 3 years before the admission to the surveillance program. All patients showed more than a thousand adenomas in the colorectal mucosa. No patients with attenuated polyposis were found.

Results

At the first endoscopy, duodenal adenomas could be detected in 19 of 50 patients (38 percent), whereas at the end of the follow-up, 43 (86 percent) had duodenal lesions. The final mean Spigelman score increased during the follow-up period (P<0.001 respect to baseline values). No duodenal cancer could be detected. Eleven patients had or developed severe precancerous duodenal lesions (Stage IV) treated with endoscopic or surgical resection. The distribution of patients with Stage IV according to the surgery of the colon was: 2 of 25 treated with ileoanal anastomosis and 8 of 15 with ileorectal anastomosis (P=0.0024, Fisher’s exact test).

Conclusions

Patients with familial adenomatous polyposis are at risk of significant neoplasia. The natural history of precancerous lesions might be related to surgical treatment of colorectal neoplasms.
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Metadata
Title
Impact of Surgery on the Development of Duodenal Cancer in Patients with Familial Adenomatous Polyposis
Authors
G. Biasco, M.D.
E. Nobili, M.D.
C. Calabrese, M.D., Ph.D.
R. Sassatelli, M.D.
L. Camellini, M.D.
M. A. Pantaleo, M.D., Ph.D.
G. Bertoni, M.D.
A. De Vivo, M.D.
M. Ponz De Leon, M.D.
G. Poggioli, M.D.
G. Bedogni, M.D.
T. Venesio, Ph.D.
L. Varesco, M.D.
M. Risio, M.D.
G. Di Febo, M.D.
G. Brandi, M.D.
Publication date
01-12-2006
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 12/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0723-y

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