title: Prevalence of laparoscopic surgical treatment and its clinical outcomes in patients with familial adenomatous polyposis in Japan.
abstract: BACKGROUND
  Laparoscopic surgery is becoming the preferred technique for most colorectal interventions. This study aimed to clarify the time trend of surgical treatment for familial adenomatous polyposis (FAP) and its relevance to clinical outcomes in Japan over a 13-year period.
  
  
  METHODS
  This was a multicenter retrospective cohort study comprising 23 specialist institutions for colorectal disease and a cohort of 282 FAP patients who underwent total colectomy or proctocolectomy during 2000-2012. Patient clinical backgrounds and surgical outcomes were compared between the first and second halves of the study period.
  
  
  RESULTS
  The proportion of surgical types adopted over the entire study period was 46, 21, 30, and 3 % for ileoanal anastomosis (IAA), ileoanal canal anastomosis, ileorectal anastomosis, and permanent ileostomy, respectively. FAP patients undergoing laparoscopic surgery have increased since 2008 and reached 74 % in the past 3 years. In particular, the number of patients undergoing laparoscopic proctocolectomy with IAA increased approximately four-fold from the first to the second half of the study period. A laparoscopic approach was increasingly used in patients with coexisting colorectal malignancies. Despite this trend, surgical results of the laparoscopic approach between the two study periods showed similar morbidity, pouch operation and stoma closure completion rates. No postoperative mortality was observed in this series, and laparoscopic surgery was comparable to open surgery in terms of stoma closure rate, incidence of intra-abdominal/abdominal desmoid tumors, and postoperative survival rate in both study periods.
  
  
  CONCLUSIONS
  Laparoscopic approach is increasingly being adopted for prophylactic FAP surgery in Japan and may provide clinically acceptable practical outcomes.
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan. ueno@ndmc.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ueno
authors.affiliation: Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Konishi
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Ishida
authors.affiliation: Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Hinoi
authors.affiliation: Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Kanemitsu
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.affiliation: Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Nagahide
authors.initials: N
authors.lastname: Matsubara
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Komori
authors.affiliation: Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
authors.forename: Heita
authors.initials: H
authors.lastname: Ozawa
authors.affiliation: Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagasaka
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hasegawa
authors.affiliation: Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Motoi
authors.initials: M
authors.lastname: Koyama
authors.affiliation: Department of Surgery, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Akagi
authors.affiliation: Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Yatsuoka
authors.affiliation: Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kumamoto
authors.affiliation: Department of Surgery 2, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Kurachi
authors.affiliation: Department of Surgery, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Kohji
authors.initials: K
authors.lastname: Tanakaya
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshimatsu
authors.affiliation: Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ishida
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D018222:Desmoid Tumors / Q000601:surgery*; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Desmoid tumor; Familial adenomatous polyposis (FAP); Laparoscopic surgery; Total colectomy; Total proctocolectomy
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