Murano Tatsuro, Ikematsu Hiroaki, Shinmura Kensuke, Okumura Kei, Kuwata Takeshi, Ushiama Mineko, Yoshida Teruhiko, Takashima Kenji, Nakajo Keiichiro, Kadota Tomohiro, Yoda Yusuke, Oono Yasuhiro, Yano Tomonori
Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1Kashiwa-shi, KashiwanohaChiba, Japan.
Department of Genetic Medicine and Services, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, Japan.
Fam Cancer. 2023 Jan;22(1):83-89. doi: 10.1007/s10689-022-00308-x. Epub 2022 Aug 5.
Preserving the colon while preventing colorectal cancer is challenging in patients with familial adenomatous polyposis. Although prophylactic colectomy is the current standard of care, some patients with familial adenomatous polyposis may wish to postpone colectomy as long as polyposis can be managed by endoscopic resection. This study examined our endoscopic management and prognostic results for patients with familial adenomatous polyposis who refused to undergo colectomy. We retrospectively analyzed the data of 12 patients with familial adenomatous polyposis treated at our hospital between January 1995 and December 2020. All patients opted to postpone prophylactic colectomy although they had significant polyp burdens and underwent endoscopic management, in which colorectal polyps sized > 5 mm were thoroughly resected during baseline colonoscopies and subsequently, newly arising colorectal polyps sized > 5 mm were periodically resected during surveillance colonoscopies. Patients (median age, 33 years) were followed up for a median of 5.2 years. The median number of colonoscopies and resected lesions per patient was 2 and 14 at baseline as well as, 9 and 32 during surveillance, respectively. The interval between colonoscopies was 1.0 and 7.0 months for baseline and surveillance, respectively. The colons of all 12 patients were preserved, and no invasive colorectal cancer developed. In 10 patients, 35 cases of high-grade dysplasia were observed and managed by endoscopic resection. Repeated endoscopic resection of colorectal polyps sized > 5 mm with appropriate surveillance may be an alternative form of endoscopic management for patients with familial adenomatous polyposis wishing to postpone colectomy.
对于家族性腺瘤性息肉病患者而言，在保留结肠的同时预防结直肠癌颇具挑战性。尽管预防性结肠切除术是当前的标准治疗方法，但一些家族性腺瘤性息肉病患者可能希望推迟结肠切除术，前提是息肉病可通过内镜切除进行管理。本研究探讨了我们对拒绝接受结肠切除术的家族性腺瘤性息肉病患者的内镜管理及预后结果。我们回顾性分析了1995年1月至2020年12月在我院接受治疗的12例家族性腺瘤性息肉病患者的数据。所有患者尽管息肉负担较重，但均选择推迟预防性结肠切除术，并接受内镜管理，即在基线结肠镜检查期间彻底切除直径>5mm的结直肠息肉，随后在监测结肠镜检查期间定期切除新出现的直径>5mm的结直肠息肉。患者（中位年龄33岁）的中位随访时间为5.2年。每位患者在基线时结肠镜检查和切除病变的中位数分别为2次和14个，在监测期间分别为9次和32个。基线和监测期间结肠镜检查的间隔分别为1.0个月和7.0个月。所有12例患者的结肠均得以保留，且未发生浸润性结直肠癌。在10例患者中，观察到35例高级别上皮内瘤变并通过内镜切除进行了处理。对于希望推迟结肠切除术的家族性腺瘤性息肉病患者，重复内镜切除直径>5mm的结直肠息肉并进行适当监测可能是一种内镜管理的替代方式。
