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DOI: 10.1055/a-2038-0541
Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis
Gefördert durch: Medical Research Council HDR-UK UKRI Rutherford Fund Fellowship Gefördert durch: National Institutes of Health P30 CA023100 Gefördert durch: Royal College of Surgeons/Bowel Cancer UK Research fellowship Gefördert durch: National Institutes of Health P30 CA023100 Gefördert durch: AGA Research Foundation AGA Research Scholar Award AGA2022-13-05
Abstract
Background Long-term pouch surveillance outcomes for familial adenomatous polyposis (FAP) are unknown. We aimed to quantify surveillance outcomes and to determine which of selected possible predictive factors are associated with pouch dysplasia.
Methods Retrospective analysis of collected data on 249 patients was performed, analyzing potential risk factors for the development of adenomas or advanced lesions ( ≥ 10 mm/high grade dysplasia (HGD)/cancer) in the pouch body and cuff using Cox proportional hazards models. Kaplan–Meier analyses included landmark time-point analyses at 10 years after surgery to predict the future risk of advanced lesions.
Results Of 249 patients, 76 % developed at least one pouch body adenoma, with 16 % developing an advanced pouch body lesion; 18 % developed an advanced cuff lesion. Kaplan–Meier analysis showed a 10-year lag before most advanced lesions developed; cumulative incidence of 2.8 % and 6.4 % at 10 years in the pouch body and cuff, respectively. Landmark analysis suggested the presence of adenomas prior to the 10-year point was associated with subsequent development of advanced lesions in the pouch body (hazard ratio [HR] 4.8, 95 %CI 1.6–14.1; P = 0.004) and cuff (HR 6.8, 95 %CI 2.5–18.3; P < 0.001). There were two HGD and four cancer cases in the cuff and one pouch body cancer; all cases of cancer/HGD that had prior surveillance were preceded by ≥ 10-mm adenomas.
Conclusions Pouch adenoma progression is slow and most advanced lesions occur after 10 years. HGD and cancer were rare events. Pouch phenotype in the first decade is associated with the future risk of developing advanced lesions and may guide personalized surveillance beyond 10 years.
‡ Contributed equally to this article
Publikationsverlauf
Eingereicht: 14. Februar 2022
Angenommen nach Revision: 15. Februar 2023
Accepted Manuscript online:
17. Februar 2023
Artikel online veröffentlicht:
22. Mai 2023
© 2023. 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
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References
- 1 Tudyka VN, Clark SK. Surgical treatment in familial adenomatous polyposis. Ann Gastroenterol 2012; 25: 201-206
- 2 Sinha A, Tekkis PP, Rashid S. et al. Risk factors for secondary proctectomy in patients with familial adenomatous polyposis. Br J Surg 2010; 97: 1710-1715
- 3 Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978; 2: 85-88
- 4 Heald RJ, Allen DR. Stapled ileo-anal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation. Br J Surg 1986; 73: 571-572
- 5 Lee CHA, Kalady MF, Burke CA. et al. Incidence and management of rectal cuff and anal transitional zone neoplasia in patients with familial adenomatous polyposis. Dis Colon Rectum 2021; 64: 977-985
- 6 von Roon AC, Will OC, Man RF. et al. Mucosectomy with handsewn anastomosis reduces the risk of adenoma formation in the anorectal segment after restorative proctocolectomy for familial adenomatous polyposis. Ann Surg 2011; 253: 314-317
- 7 Ganschow P, Treiber I, Hinz U. et al. Residual rectal mucosa after stapled vs. handsewn ileal J-pouch-anal anastomosis in patients with familial adenomatous polyposis coli (FAP)--a critical issue. Langenbecks Arch Surg 2015; 400: 213-219
- 8 Smith JC, Schaffer MW, Ballard BR. et al. Adenocarcinomas after prophylactic surgery for familial adenomatous polyposis. J Cancer Ther 2013; 4: 260-270
- 9 Tajika M, Niwa Y, Bhatia V. et al. Risk of ileal pouch neoplasms in patients with familial adenomatous polyposis. World J Gastroenterol 2013; 19: 6774-6783
- 10 Ganschow P, Trauth S, Hinz U. et al. Risk factors associated with pouch adenomas in patients with familial adenomatous polyposis. Dis Colon Rectum 2018; 61: 1096-1101
- 11 Parc YR, Olschwang S, Desaint B. et al. Familial adenomatous polyposis: prevalence of adenomas in the ileal pouch after restorative proctocolectomy. Ann Surg 2001; 233: 360-364
- 12 Tajika M, Nakamura T, Nakahara O. et al. Prevalence of adenomas and carcinomas in the ileal pouch after proctocolectomy in patients with familial adenomatous polyposis. J Gastrointest Surg 2009; 13: 1266-1273
- 13 Goldstein AL, Kariv R, Klausner JM. et al. Patterns of adenoma recurrence in familial adenomatous polyposis patients after ileal pouch-anal anastomosis. Dig Surg 2015; 32: 421-425
- 14 Tonelli F, Ficari F, Bargellini T. et al. Ileal pouch adenomas and carcinomas after restorative proctocolectomy for familial adenomatous polyposis. Dis Colon Rectum 2012; 55: 322-329
- 15 Kariv R, Rosner G, Fliss-Isakov N. et al. Genotype-phenotype associations of APC mutations with pouch adenoma in patients with familial adenomatous polyposis. J Clin Gastroenterol 2019; 53: e54-e60
- 16 Monahan KJ, Bradshaw N, Dolwani S. et al. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut 2020; 69: 411-444
- 17 McLaughlin SD, Clark SK, Thomas-Gibson S. et al. Guide to endoscopy of the ileo-anal pouch following restorative proctocolectomy with ileal pouch-anal anastomosis; indications, technique, and management of common findings. Inflamm Bowel Dis 2009; 15: 1256-1263
- 18 Anderson JR, Cain KC, Gelber RD. Analysis of survival by tumor response. J Clin Oncol 1983; 1: 710-719
- 19 Gleiss A, Oberbauer R, Heinze G. An unjustified benefit: immortal time bias in the analysis of time-dependent events. Transpl Int 2018; 31: 125-130
- 20 Boostrom SY, Mathis KL, Pendlimari R. et al. Risk of neoplastic change in ileal pouches in familial adenomatous polyposis. J Gastrointest Surg 2013; 17: 1804-1808
- 21 Wasmuth HH, Tranø G, Myrvold HE. et al. Adenoma formation and malignancy after restorative proctocolectomy with or without mucosectomy in patients with familial adenomatous polyposis. Dis Colon Rectum 2013; 56: 288-294
- 22 Friederich P, de Jong AE, Mathus-Vliegen LM. et al. Risk of developing adenomas and carcinomas in the ileal pouch in patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol 2008; 6: 1237-1242
- 23 Banasiewicz T, Marciniak R, Kaczmarek E. et al. The prognosis of clinical course and the analysis of the frequency of the inflammation and dysplasia in the intestinal J-pouch at the patients after restorative proctocolectomy due to FAP. Int J Colorectal Dis 2011; 26: 1197-1203
- 24 Pommaret E, Vienne A, Lefevre JH. et al. Prevalence and risk factors for adenomas in the ileal pouch and the afferent loop after restorative proctocolectomy for patients with familial adenomatous polyposis. Surg Endosc 2013; 27: 3816-3822
- 25 Schulz AC, Bojarski C, Buhr HJ. et al. Occurrence of adenomas in the pouch and small intestine of FAP patients after proctocolectomy with ileoanal pouch construction. Int J Colorectal Dis 2008; 23: 437-441
- 26 Thompson-Fawcett MW, Marcus VA, Redston M. et al. Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis. Dis Colon Rectum 2001; 44: 347-353
- 27 Zahid A, Kumar S, Koorey D. et al. Pouch adenomas in familial adenomatous polyposis after restorative proctocolectomy. Int J Surg 2015; 13: 133-136
- 28 Campos FG, Perez RO, Imperiale AR. et al. Surgical treatment of familial adenomatous polyposis: ileorectal anastomosis or restorative proctolectomy?. Arq Gastroenterol 2009; 46: 294-299
- 29 Moussata D, Nancey S, Lapalus MG. et al. Frequency and severity of ileal adenomas in familial adenomatous polyposis after colectomy. Endoscopy 2008; 40: 120-125
- 30 Bulow S, Bjork J, Christensen IJ. et al. Duodenal adenomatosis in familial adenomatous polyposis. Gut 2004; 53: 381-386
- 31 Remzi FH, Church JM, Bast J. et al. Mucosectomy vs. stapled ileal pouch-anal anastomosis in patients with familial adenomatous polyposis: functional outcome and neoplasia control. Dis Colon Rectum 2001; 44: 1590-1596
- 32 Bassuini MM, Billings PJ. Carcinoma in an ileoanal pouch after restorative proctocolectomy for familial adenomatous polyposis. Br J Surg 1996; 83: 506
- 33 Palkar VM, deSouza LJ, Jagannath P. et al. Adenocarcinoma arising in "J" pouch after total proctocolectomy for familial polyposis coli. Indian J Cancer 1997; 34: 16-19
- 34 Cherki S, Glehen O, Moutardier V. et al. Pouch adenocarcinoma after restorative proctocolectomy for familial adenomatous polyposis. Colorectal Dis 2003; 5: 592-594
- 35 Linehan G, Cahill RA, Kalimuthu SN. et al. Adenocarcinoma arising in the ileoanal pouch after restorative proctocolectomy for familial adenomatous polyposis. Int J Colorectal Dis 2008; 23: 329-330
- 36 Lee SH, Ahn BK, Chang HK. et al. Adenocarcinoma in ileal pouch after proctocolectomy for familial adenomatous polyposis: report of a case. J Korean Med Sci 2009; 24: 985-988
- 37 Tajika M, Nakamura T, Bhatia V. et al. Ileal pouch adenocarcinoma after proctocolectomy for familial adenomatous polyposis. Int J Colorectal Dis 2009; 24: 1487-1489