Feasibility of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis and total colectomy with ileorectal anastomosis for familial adenomatous polyposis: results of a nationwide multicenter study.
BACKGROUND
Data supporting the safety and feasibility of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) and total colectomy with ileorectal anastomosis (TC-IRA) for patients with familial adenomatous polyposis (FAP) are limited. The aim of this study was to clarify the feasibility and morbidity of laparoscopic TPC-IPAA and TC-IRA for patients with FAP, using a large Japanese multicenter dataset.


METHODS
Data on 256 patients with FAP who underwent TPC-IPAA (n = 171) or TC-IRA (n = 85) at 23 institutions between the years 2000 and 2012 were collected. Short- and long-term clinical outcomes were compared between laparoscopic and open approaches for each procedure.


RESULTS
Among the 256 patients with FAP, a total of 126 patients underwent laparoscopic surgery, consisting of 74 laparoscopic TPC-IPAAs and 52 laparoscopic TC-IRAs. The proportion of the FAP patients who underwent laparoscopic surgery increased during the study period, reaching 79 % of all TPC-IPAAs and 82 % of all TC-IRAs in the final two years covered by the data. In both TPC-IPAA and TC-IRA, the laparoscopic approach was associated with a longer operative duration but a similarly low postoperative morbidity and comparably adequate anal function compared with the open approach. The overall survival and the incidence of desmoid tumor were also comparable between the laparoscopic and open approaches in both procedures.


CONCLUSIONS
Laparoscopic TPC-IPAA and TC-IRA are both feasible options-with low rates of morbidity, good functional outcomes, and excellent overall survival rates-in patients with FAP. Since the data indicate that laparoscopic TPC-IPAA and TC-IRA are feasible, they also support the recent increase in laparoscopic surgery for patients with FAP in Japan.
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. tkonishi-tky@umin.ac.jp.|Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan. tkonishi-tky@umin.ac.jp.
Tsuyoshi
T
Konishi
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Hideyuki
H
Ishida
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Department of Surgery, National Defense Medical College, Saitama, Japan.
Hideki
H
Ueno
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Hirotoshi
H
Kobayashi
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima, Japan.
Takao
T
Hinoi
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Yasuhiro
Y
Inoue
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Digestive Disease Center, Northern Yokohama Hospital, Showa University, Yokohama, Japan.
Fumio
F
Ishida
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
Yukihide
Y
Kanemitsu
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Tatsuro
T
Yamaguchi
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
Naohiro
N
Tomita
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
Nagahide
N
Matsubara
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Toshiaki
T
Watanabe
Study Group for Familial Adenomatous Polyposis in the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.|Tokyo Medical and Dental University, Tokyo, Japan.
Kenichi
K
Sugihara
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002648:Child; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D039021:Colonic Pouches / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D018222:Desmoid Tumors / Q000453:epidemiology*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
Familial adenomatous polyposis; Ileal pouch–anal anastomosis; Ileorectal anastomosis; Laparoscopic surgery; Total colectomy; Total proctocolectomy