Bouchiba Hicham, Aelvoet Arthur S, Pellisé Maria, Bastiaansen Barbara A J, van Leerdam Monique E, Langers Alexandra M J, Balaguer Francesc, Miedema Thymen N, Anele Chukwuemeka C, Daca-Alvarez Maria, Bossuyt Patrick M M, Ricciardiello Luigi, Jover Rodrigo, Hompes Roel, Karstensen John G, Latchford Andrew, Dekker Evelien
Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Cancer Center Amsterdam, Amsterdam, the Netherlands.
Am J Gastroenterol. 2024 Dec 31;120(9):2132-2138. doi: 10.14309/ajg.0000000000003273.
To prevent colorectal cancer, most patients with familial adenomatous polyposis (FAP) undergo (procto)colectomy with ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA). After surgery, these patients remain at risk of developing cancer in the remnant rectum or rectal cuff/pouch. We aimed to compare the long-term risk of cancer after IRA or IPAA in FAP.
We performed an international multicenter historical cohort study of FAP patients undergoing IRA or IPAA from 1990 to 2023. The proportion of patients developing cancer after surgery was estimated using the Kaplan-Meier method.
(Procto)colectomy was performed in 685 patients (53.6% female); 366 (53.4%) had IRA, and 319 (46.6%) had IPAA. Median age at IRA and IPAA was 23 and 27 years, and the median follow-up was 12 and 15 years, respectively. Overall, 8 patients (2.2%) developed rectal and/or rectal cuff/pouch cancer after IRA and 0.9% after IPAA. The estimated 10- and 20-year cancer incidence after IRA vs IPAA was 1.6% vs 0.4% and 2.5% vs 0.9%, respectively (log-rank P = 0.15). Reoperations, mainly for extensive polyposis, were performed in 39 (10.7%) patients with an IRA and 24 (7.5%) patients after IPAA. The number of postoperative endoscopic surveillance endoscopies was higher in patients with an IRA compared with those with an IPAA ( P < 0.001).
Over the past 3 decades, few patients were diagnosed with cancer in the rectum or rectal cuff/pouch after (procto)colectomy in FAP. This might be due to an improved selection of the type of (procto)colectomy and close endoscopic surveillance including prophylactic polypectomies.
为预防结直肠癌，大多数家族性腺瘤性息肉病（FAP）患者会接受（直肠）结肠切除术并进行回肠直肠吻合术（IRA）或回肠贮袋肛管吻合术（IPAA）。术后，这些患者仍有在残留直肠或直肠袖口/贮袋发生癌症的风险。我们旨在比较FAP患者接受IRA或IPAA术后发生癌症的长期风险。
我们对1990年至2023年接受IRA或IPAA的FAP患者进行了一项国际多中心历史队列研究。使用Kaplan-Meier方法估计术后发生癌症的患者比例。
685例患者接受了（直肠）结肠切除术（女性占53.6%）；366例（53.4%）接受IRA，319例（46.6%）接受IPAA。IRA和IPAA的中位年龄分别为23岁和27岁，中位随访时间分别为12年和15年。总体而言，8例（2.2%）接受IRA的患者术后发生直肠和/或直肠袖口/贮袋癌，接受IPAA的患者为0.9%。IRA与IPAA术后估计的10年和20年癌症发病率分别为1.6%对0.4%和2.5%对0.9%（对数秩检验P = 0.15）。主要因广泛性息肉病进行再次手术的患者，接受IRA的有39例（10.7%），接受IPAA的有24例（7.5%）。接受IRA的患者术后内镜监测内镜检查的次数高于接受IPAA的患者（P < 0.001）。
在过去30年中，FAP患者在（直肠）结肠切除术后很少被诊断出直肠或直肠袖口/贮袋癌。这可能是由于（直肠）结肠切除术类型的选择改善以及包括预防性息肉切除术在内的密切内镜监测。
