Management of an Obese Patient with Familial Adenomatous Polyposis: Surgical Implication of Biliopancreatic Diversion and Total Colectomy

Excerpt

Obesity, defined as body mass index (BMI) greater than 30 kg/m², is a major worldwide multisystem condition considered to be the fifth leading risk factor for mortality. Obesity is associated with several comorbidities: type two diabetes, dyslipidemia, hypertension, heart disease, stroke, asthma, and cancer. Bariatric surgery (BS) is indicated when lifestyle modifications are ineffective. BS is effective both for weight loss and for improving and remitting obesity-related comorbidities [1]. Biliopancreatic diversion (BPD) is considered very effective for marked weight loss and comorbidity reduction [1]. Familial adenomatous polyposis (FAP) is a highly penetrant rare hereditary autosomal dominant syndrome caused by germline mutations in the tumor suppressor gene APC. FAP is characterized by the development of hundreds to thousands of adenomas of the colorectal epithelium from the 2nd decade of life [2]. FAP is characterized by lifetime risk of 95–100% to early develop colorectal cancer (CRC) if not adequately treated [2]. The severity of FAP could be also associated with the type of APC mutation [3]. FAP is a systemic syndrome that could be also characterized by the development of extracolonic tumors (duodenal, thyroid, brain, liver, and pancreas). Ten to 25% of FAP patients develop desmoid tumors (DT) in the abdomen and the abdominal wall, especially after surgical procedures. DT are fibrous benign tumors characterized by aggressive infiltrating growth harming the surrounding vital structures [4]. Surgery is the mainstay of FAP treatment. Extended colonic resections (e.g., total colectomy or proctocolectomy) are performed with prophylactic aim (CRC prevention) generally from the second decade of life [5]. The association between obesity and cancer has been studied with identification of different cellular and molecular pathways; however, no relation between obesity and FAP has yet been studied [6, 7]. …