Is Leaving the Rectum in Place in Familial Adenomatous Polyposis Still Okay?
Douglas K. Rex, MD, MASGE, reviewing Pasquer A, et al. Endosc Int Open 2021 Jul.
In this study from a French hospital, 296 patients with familial adenomatous polyposis (FAP) underwent either proctocolectomy with ileoanal anastomosis (IAA; 31.1%) or abdominal colectomy with ileorectal anastomosis (IRA; 66.5%). Seven patients with abdominal perineal resections were excluded. Second cancers occurred in 6.1% of the IRA group versus 1.1% of the IAA group. The 15-year cancer-free survival rates were 99.5% for IRA and 100% for IAA. The mean number of stools per day was higher in the IAA group (4.4 vs 5.5), and fecal incontinence was higher with IAA (7.1% vs 17.4%). At least one episode of postprocedure bleeding occurred in 16.8% of the IRA group and 15.2% in the IAA group.
COMMENTThese data suggest that abdominal colectomy with ileorectal anastomosis is still an acceptable option in FAP. Whereas older data suggested that large rectal polyp burdens are an indicator for IAA, in our experience, we still offer IRA after clearing up to hundreds of polyps from the rectum preoperatively. Cold snaring has transformed the management of FAP for both colorectal polyps and duodenal polyps, allowing debulking of large numbers of polyps, with almost no risk of complications. These patients are managed best with the help of a program coordinator who can routinely contact them to keep up with prescribed follow-up.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Pasquer A, Benech N, Pioche M, et al. Prophylactic colectomy and rectal preservation in FAP: systematic endoscopic follow-up and adenoma destruction changes natural history of polyposis. Endosc Int Open 2021;9:E1014-E1022. (https://doi.org/10.1055/a-1467-6257)
