title: Desmoid tumors do not prevent proctectomy following abdominal colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis.
abstract: BACKGROUND
  Elective proctocolectomy has been recommended for patients at high risk of desmoids based on the possibility that cancer in a retained rectum may be unresectable because of desmoid disease. There are no data to support the reality of this concern.
  
  
  OBJECTIVE
  The aim of this study was to see how often proctectomy was prevented by desmoids.
  
  
  METHODS
  This retrospective, descriptive, database study was augmented by chart review.
  
  
  METHODS
  This study was conducted at a hereditary colorectal cancer clinic in a tertiary referral center.
  
  
  METHODS
  Those presenting for proctectomy after colectomy and ileorectal anastomosis for familial adenomatous polyposis were selected.
  
  
  METHODS
  Patients underwent a proctectomy.
  
  
  METHODS
  The primary outcomes measured were the rate of proctectomy, rate of IPAA, and the incidence of desmoid disease.
  
  
  RESULTS
  Sixty- seven patients, 34 men and 33 women, underwent an operation with the intent of performing proctectomy. Mean age at surgery was 39.7 years, an average of 175 months from ileorectal anastomosis. Indications for proctectomy were uncontrollable adenomas in 56, cancer in 8, and high-grade dysplasia in 3. Proctectomy was always possible. Ileal pouch-anal anastomosis was planned in 62 patients; 54 had this operation. Desmoid disease was found in 26 patients (38.8%) and influenced surgery in 13 cases, stopping pouch-anal anastomosis in 8. One patient had no resection, 2 had a pouch-low rectal anastomosis, and 5 had proctectomy and ileostomy. Proctectomy and ileostomy was planned in 5 patients and performed in all.
  
  
  CONCLUSIONS
  This is a retrospective review from a single institution.
  
  
  CONCLUSIONS
  The fear of an unresectable rectum or an impossible pouch-anal anastomosis should not be an indication for proctectomy in patients with low rectal polyp counts but a high risk for desmoid disease.
authors: 1Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio 2Sanford R Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, Ohio 3Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors: James M
authors: JM
authors: Church
authors: Xhileta
authors: X
authors: Xhaja
authors: Satish K
authors: SK
authors: Warrier
authors: Lisa
authors: L
authors: Laguardia
authors: Margaret
authors: M
authors: O'Malley
authors: Carol
authors: C
authors: Burke
authors: Matthew F
authors: MF
authors: Kalady
mesh_terms: D000005:Abdomen / Q000601:surgery; D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical; D003082:Colectomy; D005260:Female; D018222:Desmoid Tumors / Q000601:surgery*; D006801:Humans; D008297:Male; D016737:Proctocolectomy, Restorative; D012007:Rectum / Q000601:surgery; D016896:Treatment Outcome