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Familial Cancer
Published in: Familial Cancer 2/2015

01-06-2015 | Original Article

Comparison of proctocolectomy and ileal pouch-anal anastomosis to colectomy and ileorectal anastomosis in familial adenomatous polyposis

Authors: L. Koskenvuo, H. Mustonen, L. Renkonen-Sinisalo, H. J. Järvinen, A. Lepistö

Published in: Familial Cancer | Issue 2/2015

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Abstract

Prophylactic surgical options for familial adenomatous polyposis (FAP) are either colectomy and ileorectal anastomosis (IRA) or proctocolectomy and ileal pouch-anal anastomosis (IPAA). The aim of this study was to analyse the short-term and long-term outcomes of these two operative techniques. All patients with FAP in Finland have been prospectively recorded in a database since 1963 were retrospectively reviewed in this analysis. Altogether 140 (61 %) colectomies with IRA and 88 (39 %) proctocolectomies with IPAA have been performed. Complications occurred in 28 (21 %) patients after IRA and in 26 (30 %) patients after IPAA. There were 15 (11 %) severe complications for IRA and 5 (6 %) for IPAA. Twenty-one (15 %) patients of the IRA group ended up in conventional ileostomy whereas 3 (3.4 %) patients of the IPAA group had their ileal reservoir converted to an ileostomy (p = 0.01). Cumulative survival for IRA was lower than for the IPAA (p = 0.03), but if accounting only for operations made after the IPAA era had commenced, there was no significant difference. IPAA was associated with improved long-term survival without an increase in postoperative complications. The risk of death after colectomy and IRA seemed to be predominantly related to the remaining risk of rectal cancer. Therefore, we favour proctocolectomy with IPAA as the prophylactic surgical procedure for FAP with intermediate or severe polyposis.
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Metadata
Title
Comparison of proctocolectomy and ileal pouch-anal anastomosis to colectomy and ileorectal anastomosis in familial adenomatous polyposis
Authors
L. Koskenvuo
H. Mustonen
L. Renkonen-Sinisalo
H. J. Järvinen
A. Lepistö
Publication date
01-06-2015
Publisher
Springer Netherlands
Published in
Familial Cancer / Issue 2/2015
Print ISSN: 1389-9600
Electronic ISSN: 1573-7292
DOI
https://doi.org/10.1007/s10689-014-9773-9

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