Ileal pouch-anal anastomosis with mesorectal excision for rectal cancer complicating familial adenomatous polyposis.

OBJECTIVE

To assess the long term results of ileal pouch-anal anastomosis (IPAA) with mesorectal excision for rectal carcinoma complicating familial adenomatous polyposis (FAP).

DESIGN

Retrospective study.

SETTING

Teaching hospital, France.

SUBJECTS

6 patients with FAP and associated rectal carcinoma and 87 patients who underwent IPAA for benign disease.

MAIN OUTCOMES MEASURES

Morbidity and mortality.

RESULTS

There were no postoperative deaths and no significant differences between the groups in postoperative morbidity. Mean follow-up was 35 months. Two patients in the cancer group died 33 and 40 months after IPAA of liver metastases, but had no evidence of local recurrence. There were no recurrences among the other 4 patients. There were no significant differences between the groups in stool frequency, continence, gas/stool discrimination, leak, or need for protective pads. The risk of impotence and retrograde ejaculation was higher (but not significantly) in men with rectal cancer than in those with benign disease (1/4, 25% compared with 1/47, 2%; p = 0.15).

CONCLUSION

In cases of rectal carcinoma complicating FAP, IPAA with mesorectal excision should be proposed as an alternative to coloproctectomy with definitive ileostomy. Long term functional evaluation showed that continence and defaecation were similar to those followed up after IPAA for benign disease.