Matsumoto T, Iida M, Mibu R, Fujishima M
Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Hepatogastroenterology. 1995 Nov-Dec;42(6):765-70.
BACKGROUND/AIMS: Current treatment for familial adenomatous polyposis usually entails total colectomy. However, the question of whether or not to remove the rectum has yet answered decisively. This paper represents an attempt to clarify the position on whether the surgeon should remove the rectum.
Twenty patients from 16 families with the established diagnosis of FAP, or Gardner's syndrome, who had been treated by total colectomy with ileorectal anastomosis, were followed up by proctoscopy for at least 5 years. The clinical features were compared between the patients with histologically verified rectal cancer and those who had been free from cancer development.
During the observation periods ranging from 5 to 27 years (mean, 11.4 years), five rectal cancers were identified in 4 patients. These cancers included two cancers in adenomas, two nonpolypoid cancers, and one invasively ulcerating tumor. While the clinical and pathologic features at surgery and the incidence of colonic cancer in the resected specimen had not differed between the patients with rectal cancer and those without cancer, the former group of patients had more colonic polyps and they tended to have been observed over longer periods than the latter group of patients.
These findings suggest that clinical features at surgery of patients with FAP are not relevant for predicting the development of rectal cancer during follow-up.
背景/目的：家族性腺瘤性息肉病的当前治疗通常需要全结肠切除术。然而，是否切除直肠的问题尚未得到明确解答。本文旨在阐明外科医生是否应切除直肠这一问题的立场。
对来自16个家庭的20例已确诊为家族性腺瘤性息肉病或加德纳综合征且接受了全结肠切除回直肠吻合术治疗的患者进行了至少5年的直肠镜随访。对组织学确诊为直肠癌的患者与未发生癌症的患者的临床特征进行了比较。
在5至27年（平均11.4年）的观察期内，4例患者中发现了5例直肠癌。这些癌症包括腺瘤中的2例癌症、2例无息肉样癌症和1例浸润性溃疡性肿瘤。虽然直肠癌患者与无癌患者在手术时的临床和病理特征以及切除标本中结肠癌的发生率没有差异，但前一组患者的结肠息肉更多，且他们的观察期往往比后一组患者更长。
这些发现表明，家族性腺瘤性息肉病患者手术时的临床特征与预测随访期间直肠癌的发生无关。
