title: Adenoma formation and malignancy after restorative proctocolectomy with or without mucosectomy in patients with familial adenomatous polyposis.
abstract: BACKGROUND
  There is controversy concerning whether or not to perform mucosectomy after IPAA in patients with familial adenomatous polyposis. Although more frequent adenoma formation at the anastomotic site in patients without a mucosectomy is documented, the interpretation of the theoretical reflections and empirical findings are ambiguous.
  
  
  OBJECTIVE
  The aim of this study was to assess the differences in adenoma formation at the anastomotic site and in the ileal pouch among patients with familial adenomatous polyposis after IPAA with or without mucosectomy.
  
  
  METHODS
  Data were gathered from The Norwegian Polyposis Registry and The Cancer Registry of Norway.
  
  
  METHODS
  Sixty-one patients with familial adenomatous polyposis who had IPAA were included in the Norwegian Polyposis Registry.
  
  
  METHODS
  The frequency of adenoma development in the pouch or at the anastomotic site was measured.
  
  
  RESULTS
  Thirty-nine patients had a pelvic pouch performed with mucosectomy and 22 patients without. The observational time was 15.5 and 13.7 years. Adenoma formation at the anastomotic site was 4 in 39 and 14 in 22, and the estimated rate was 17% vs 75% (p = 0.0001). One patient without mucosectomy had a cancer (Dukes A) at the anastomotic site. There was no estimated long-term difference in adenoma formation in the ileal pouches between the 2 surgical procedures (38%) (p = 0.10).
  
  
  CONCLUSIONS
  The study is retrospective, in part, and relies on data from registries. There is a limited number of cases, and selection bias because of surgeon preference may exist.
  
  
  CONCLUSIONS
  In patients with familial adenomatous polyposis who undergo IPAA, adenoma formation at the anastomotic site is significantly reduced after mucosectomy. Mucosectomy may be the preferable procedure to prevent adenomas at the anastomotic site.
authors: Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. Hans.Wasmuth@stolav.no
authors: Hans H
authors: HH
authors: Wasmuth
authors: Gerd
authors: G
authors: Tranø
authors: Helge E
authors: HE
authors: Myrvold
authors: Lars
authors: L
authors: Aabakken
authors: Arne
authors: A
authors: Bakka
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D011125:Adenomatous Polyposis Coli / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult