title: Is laparoscopic surgery an option to support prophylactic colectomy in adolescent patients with Familial Adenomatous Polyposis (FAP)?
abstract: BACKGROUND
  Prophylactic surgery is still considered the standard treatment for patients with Familial Adenomatous Polyposis (FAP). Laparoscopic (Lap) surgery has been introduced as an alternative approach. The aim was to evaluate the feasibility and short- to long-term outcomes after prophylactic FAP surgery in adolescent.
  
  
  METHODS
  A retrospective review of a database of adolescent patients with FAP identified through the Hereditary Colorectal Tumor Registry in a single Institution between 2005 and 2011. Patients underwent Lap total colectomy (TC) with ileo-rectal anastomosis (IRA) or proctocolectomy (PC) with ileal-pouch anal anastomosis (IPAA). The main outcomes were: Hospital stay, postoperative complications, desmoid tumor rates, tumor recurrence, long-term complications.
  
  
  RESULTS
  Sixteen consecutive patients with median age 16 (range 13-19) and median BMI 22 (17-29) underwent surgery. [correction made here after initial online publication]. Of them 14 patients had LAP TC with IRA and 2 had PC with IPAA. Operative time (median, range) was TC/IRA 270 (210-330) minutes; PC/IPAA 370 (360-380) minutes. Length of extraction site was cm (median, range) 6(5-8). Lymph Node harvest (median, range) 81 (32-139). Postoperative stay days (median, range) were 6 (4-24). Five patients (31.2%) showed dysplasia on the pathological report and 3 of them showed severe dysplasia. Median follow-up time (FU) was 39 months, range (10-82). The anastomotic leak rate for 30 days was 2 (12.5%). Pouch failure was 0. Post-surgical desmoid tumors rate was 1 (6.2%) and there was no tumor recurrence. Anastomotic stricture, SBO and mortality were zero.
  
  
  CONCLUSIONS
  Lap approach is feasible and shows acceptable postoperative outcomes. Lap surgery can be an appealing alternative for prophylactic surgery in adolescent FAP patients. Pediatr Blood Cancer 2012; 59: 1223-1228. © 2012 Wiley Periodicals, Inc.
authors.affiliation: Colorectal Cancer Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. marco.vitellaro@istitutotumori.mi.it
authors.forename: Marco
authors.initials: M
authors.lastname: Vitellaro
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrari
authors.forename: Koiana
authors.initials: K
authors.lastname: Trencheva
authors.forename: Paola
authors.initials: P
authors.lastname: Sala
authors.forename: Maura
authors.initials: M
authors.lastname: Massimino
authors.forename: Luigi
authors.initials: L
authors.lastname: Piva
authors.forename: Lucio
authors.initials: L
authors.lastname: Bertario
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D003082:Colectomy / Q000009:adverse effects; D039021:Colonic Pouches; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D055815:Young Adult