title: Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis.
abstract: OBJECTIVE
  We evaluated the short- and long-term outcomes of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC/IPAA) for treatment of familial adenomatous polyposis (FAP). Also, we assessed the oncologic outcomes in FAP patients with coexisting malignancy.
  
  
  METHODS
  From August 1999 to September 2010, 43 FAP patients with or without coexisting malignancy underwent TPC/IPAA by a laparoscopic-assisted or hand-assisted laparoscopic surgery.
  
  
  RESULTS
  The median age was 33 years (range, 18 to 58 years) at the time of operation. IPAA was performed by a hand-sewn method in 21 patients (48.8%). The median operative time was 300 minutes (range, 135 to 610 minutes), which reached a plateau after 22 operations. Early postoperative complications within 30 days occurred in 7 patients (16.3%) and long-term morbidity occurred in 15 patients (34.9%) including 6 (14.0%) with desmoid tumors and 3 (7.0%) who required operative treatment. Twenty-two patients (51.2%) were diagnosed with coexisting colorectal malignancy. The median follow-up was 58.5 months (range, 7.9 to 97.8 months). There was only 1 case of local recurrence in the pelvic cavity. No cases of adenocarcinoma at the residual rectal mucosa developed. 5-year disease-free survival rate for 22 patients who had coexisting malignancy was 86.5% and 5-year overall survival rate was 92.6%. Three patients died from pulmonary or hepatic metastasis.
  
  
  CONCLUSIONS
  Laparoscopic TPC/IPAA in patients with FAP is feasible and offers favorable postoperative outcomes. It also delivered acceptable oncological outcomes in patients with coexisting malignancy. Therefore, laparoscopic TPC/IPAA may be a favorable treatment option for FAP.
authors.affiliation: Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Gyu-Seog
authors.initials: GS
authors.lastname: Choi
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Soo Yeun
authors.initials: SY
authors.lastname: Park
authors.forename: Wohn Ho
authors.initials: WH
authors.lastname: Choi
authors.forename: Jong Pil
authors.initials: JP
authors.lastname: Ryuk