Tajika Masahiro, Tanaka Tsutomu, Ishihara Makoto, Hirayama Yutaka, Oonishi Sachiyo, Mizuno Nobumasa, Kuwahara Takamichi, Okuno Nozomi, Matsumoto Shinpei, Ooshiro Taihei, Kinoshita Takashi, Komori Koji, Bhatia Vikram, Hara Kazuo, Yatabe Yasushi, Niwa Yasumasa
Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
Endosc Int Open. 2019 May;7(5):E691-E698. doi: 10.1055/a-0849-9465. Epub 2019 May 8.
Restorative proctocolectomy has become the most common surgical option for patients with familial adenomatous polyposis (FAP). However, adenomas and even carcinomas may develop in the ileal pouch over time. The aim of this study was to evaluate the long-term incidence and nature of ileal pouch or distal ileal adenomas and carcinomas in patients with FAP. This was a retrospective study of 47 FAP patients with Kock's continent ileostomy (Kock) (n = 8), ileorectal anastomosis (IRA) (n = 13), and ileal pouch-anal anastomosis (IPAA) (n = 26). Patients were followed with a standardized protocol including chromoendoscopy and biopsies of visible polyps in the ileal pouch, distal ileum, and rectum every 6 to 12 months. Median follow-up was 21.0 years. Overall risk of adenoma development was significantly higher in IRA patients, with incidence rates of 85 % and 100 % at 5 and 10 years' follow-up, respectively, compared to pouch patients (Kock + IPAA) ( < 0.001). However, there was also a high frequency of adenomas in the ileal pouch mucosa, with rates of 12 %, 33 %, and 68 %, at 5, 10, and 20 years of follow-up, respectively. Maximum size of ileal pouch adenomas was significantly related to time since surgery ( = 0.0214). Six cases of advanced adenomas including two cases of adenocarcinomas developed in the ileal pouch mucosa. There is a significant incidence of adenoma(s) in the ileal pouch of FAP patients on long-term follow-up. Regular endoscopic surveillance is recommended, not only in IRA patients, but also in pouch patients after proctocolectomy.
全直肠系膜切除术已成为家族性腺瘤性息肉病（FAP）患者最常见的手术选择。然而，随着时间的推移，回肠贮袋内可能会出现腺瘤甚至癌。本研究的目的是评估FAP患者回肠贮袋或回肠远端腺瘤及癌的长期发病率和性质。这是一项对47例FAP患者的回顾性研究，这些患者分别接受了Kock可控性回肠造口术（Kock）（n = 8）、回肠直肠吻合术（IRA）（n = 13）和回肠贮袋肛管吻合术（IPAA）（n = 26）。患者按照标准化方案进行随访，包括每6至12个月进行一次色素内镜检查以及对回肠贮袋、回肠远端和直肠中可见息肉进行活检。中位随访时间为21.0年。IRA患者腺瘤发生的总体风险显著更高，在随访5年和10年时的发病率分别为85%和100%，相比之下，贮袋患者（Kock + IPAA）的发病率则较低（P < 0.001）。然而，回肠贮袋黏膜中腺瘤的发生率也很高，在随访5年、10年和20年时分别为12%、33%和68%。回肠贮袋腺瘤的最大尺寸与手术时间显著相关（P = 0.0214）。回肠贮袋黏膜中有6例进展性腺瘤，包括2例腺癌。FAP患者回肠贮袋在长期随访中有显著的腺瘤发生率。建议进行定期内镜监测，不仅适用于IRA患者，也适用于直肠结肠切除术后的贮袋患者。
