title: Different surgical strategies in the treatment of familial adenomatous polyposis: what's the role of the ileorectal anastomosis?
abstract: Prophylactic (procto-) colectomy is the treatment of choice to reduce the risk of colorectal cancer in FAP patients with multiple adenomas. Because patients present at young age, rectum-sparing surgery is sometimes advocated, so that there is no pelvic dissection with impact on quality of life, preserved pelvic innervation and sexual function and fertility. The main disadvantage of a total colectomy with an ileorectal anastomosis (IRA) is a rectal cancer risk of 50% at the age of 50 years and a cumulative risk of 25.8% after 25 years of follow-up. Therefore, this procedure should be reserved for patients with an unaffected rectum. There should be no discussion to perform a primary IPAA in patients with multiple rectal adenomas (> 20) or those with a severe dysplastic or large (> 3 cm) rectal adenoma or a cancer elsewhere in the colon. A patient with an IRA should undergo yearly follow-up by rectoscopy.
authors: Belgian Polyposis Project, Familial Adenomatous Polyposis Association (FAPA), Brussels. info@belgianfapa.be
authors: Albert M
authors: AM
authors: Wolthuis
authors: Daniel
authors: D
authors: Leonard
authors: Alex
authors: A
authors: Kartheuser
authors: Luc
authors: L
authors: Bruyninx
authors: Jean
authors: J
authors: Van De Stadt
authors: Eric
authors: E
authors: Van Cutsem
authors: André
authors: A
authors: D'Hoore
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000453:epidemiology / Q000601:surgery*; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors