title: Does intra-abdominal desmoid disease affect patients with an ileal pouch differently than those with an ileorectal anastomosis?
abstract: BACKGROUND
  Nobody has analyzed the sequelae of desmoids according to the type of surgery that precipitated them.
  
  
  OBJECTIVE
  This study aims to determine whether the clinical effects of abdominal desmoids would be worse in patients with restorative proctocolectomy than in patients with ileorectal anastomosis.
  
  
  METHODS
  This is a retrospective, database study.
  
  
  METHODS
  Included were patients with familial adenomatous polyposis who had undergone proctocolectomy with IPAA or colectomy and ileorectal anastomosis, and subsequently developed an intra-abdominal desmoid tumor.
  
  
  METHODS
  The primary outcome measures were the clinical course of the desmoids; morbidity, and the requirement for stoma.
  
  
  RESULTS
  There were 86 patients: 49 had restorative proctocolectomy and 37 had ileorectal anastomosis. Patient demographics were similar. Average follow-up was 9.8 years (range, 2.7-23.8) and 16.3 years (range, 2.3 - 42.9). Treatment of the desmoids included surgery (64.4% vs 65.6%), medical therapy (69.4% vs 59.5%), chemotherapy (36.2% vs 30.0%), and radiotherapy (4.5% vs 10.0%), and was the same for each group. The overall complication rate of desmoids was similar, approaching 70%. The risk of individual complications was also similar (bleeding (2.0% vs 0.0%), fistula (10.2% vs 13.5%), bowel obstruction (32.7% vs 48.6%), pain (34.7% vs 21.6%), and death related to desmoid tumors (2.0% vs 10.8%)); 38.8% of the restorative proctocolectomy group and 51.4% the ileorectal group had surgery for desmoid tumor complications (P = .21), and 22.4% and 22.2% of patients ultimately had permanent stomas.
  
  
  CONCLUSIONS
  This study was limited by the relatively small numbers of patients.
  
  
  CONCLUSIONS
  The morbidity associated with desmoid tumors has not been shown to differ, whether they arise after restorative proctocolectomy or ileorectal anastomosis.
authors: Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia, Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors: A
authors: A
authors: Burgess
authors: X
authors: X
authors: Xhaja
authors: J
authors: J
authors: Church
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D039021:Colonic Pouches; D005260:Female; D018221:Fibromatosis, Abdominal / Q000150:complications* / Q000601:surgery; D018222:Desmoid Tumors / Q000150:complications* / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult