Risk of cancer development in the rectal remnant of patients with familial adenomatous polyposis/Gardner's syndrome.

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.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.