CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E1014-E1022
DOI: 10.1055/a-1467-6257
Original article

Prophylactic colectomy and rectal preservation in FAP: systematic endoscopic follow-up and adenoma destruction changes natural history of polyposis

Arnaud Pasquer
1  Digestive and Oncological Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
2  University Claude Bernard Lyon I, Faculté de Médecine Lyon Est, Lyon, France
,
Nicolas Benech
3  Hepato-gastroenterology Department Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Mathieu Pioche
2  University Claude Bernard Lyon I, Faculté de Médecine Lyon Est, Lyon, France
3  Hepato-gastroenterology Department Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Antoine Breton
1  Digestive and Oncological Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Jerome Rivory
3  Hepato-gastroenterology Department Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Olivier Vinet
3  Hepato-gastroenterology Department Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Gilles Poncet
1  Digestive and Oncological Surgery Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
2  University Claude Bernard Lyon I, Faculté de Médecine Lyon Est, Lyon, France
,
Jean Christophe Saurin
2  University Claude Bernard Lyon I, Faculté de Médecine Lyon Est, Lyon, France
3  Hepato-gastroenterology Department Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
› Author Affiliations

Abstract

Background and study aims Prophylactic surgery of familial adenomatous polyposis (FAP) includes total colectomy with ileorectal anastomosis (IRA) to proctocolectomy with ileoanal anastomosis (IAA). Surgical guidelines rely on studies without systematic endoscopic follow-up and treatment. Our aim was to report our experience based on a different approach: therapeutic follow-up, comparing in this setting IRA and IAA in terms of oncological safety and quality of life.

Patients and methods Between January 1965 and November 2015, all patients who underwent prophylactic surgery for FAP with therapeutic endoscopic follow-up in Lyon University hospital: systematic endoscopic treatment of adenomas, were retrospectively and prospectively (since 2011) included.

Results A total of 296 patients were analyzed: 92 had proctocolectomy with IAA (31.1 %), 197 total colectomy with IRA (66.5 %), and seven abdominoperineal resections (2.4 %). Median follow-up was 17.1 years (range, 0–38.1). Incidence of secondary cancer (IR vs. IAA) was 6.1 % vs. 1.1 % (P = 0.06; 95 %CI 0.001–0.36). The 15-year cancer-free and overall survival (IR vs. IAA) were 99.5 % vs 100 % (P = 0.09) and 98.9 % vs. 98.8 % (P = 0.82), respectively. Postoperative morbidity occurred in 44 patients: 29 (14.7 %) in the IRA and 15 (16.3 %) in the IAA group (P = 0.72). The mean number of stools per day in the respective groups were 4.4 (2.5) vs. 5.5 (2.6) (P = 0.001). Fecal incontinence occurred in 14 patients (7.1 %) in the IRA vs. 16 (17.4 %) in the IAA group (P = 0.03).

Conclusions A combination of therapeutic endoscopic treatment and extended rectal preservation appears to be a safe alternative to ileoanal J-pouch anastomosis.



Publication History

Received: 23 February 2021

Accepted: 04 March 2021

Publication Date:
17 June 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany