Long-term outcome of metachronous rectal cancer following ileorectal anastomosis for familial adenomatous polyposis.
BACKGROUND
Total colectomy with ileorectal anastomosis (IRA) for familial adenomatous polyposis (FAP) carries a potential risk of metachronous cancer in the residual rectum. This study evaluated the risk of cancer development in the residual rectum.


METHODS
Ninety-six patients who underwent initial surgery for prevention and cure of FAP were studied, and a clinicopathologic comparison was conducted between 59 patients who underwent IRA and 24 who underwent total proctocolectomy.


RESULTS
The 5-year overall survival rates were 94% after IRA and 95% after total proctocolectomy with no significant difference. The incidence of dense-type rectal polyps (4/17, 24%) was significantly higher in patients who developed metachronous rectal cancer following IRA compared to that in patients who did not (1/39, 3%). Moreover, 60% of patients with dense-type colon polyps developed metachronous rectal cancer compared to 24% in patients without and 80% of those with dense type rectal polyps developed metachronous rectal cancer compared to 25% without. Endoscopic surveillance of the eight Tis or T1 patients was performed at intervals of 6 months to 1 year after IRA but was not performed in three T3 patients for more than 2 years.


CONCLUSIONS
Effective IRA requires selection of patients without invasive rectal cancer and without dense rectal polyps in whom long-term postoperative follow-up of the residual rectum is possible.
Yamaguchi
Tomohiro
T
Colorectal Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Yamamoto
Seiichiro
S
Fujita
Shin
S
Akasu
Takayuki
T
Moriya
Yoshihiro
Y
D011125:Adenomatous Polyposis Coli / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D039021:Colonic Pouches; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D012004:Rectal Neoplasms / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult