title: Current status of prophylactic surgical treatment for familial adenomatous polyposis in Japan.
abstract: OBJECTIVE
  We conducted this study to clarify the current clinical practice of prophylactic colectomy for patients with familial adenomatous polyposis (FAP) in Japan.
  
  
  METHODS
  This retrospective multi-center cohort study involved 23 specialized institutions for colorectal disease in Japan. We analyzed the records of 147 patients who underwent prophylactic surgical treatment between 2000 and 2012. Patients were divided into Group 1 (2000-2006) and Group 2 (2007-2012) based on their date of surgery.
  
  
  RESULTS
  Age at the time of prophylactic surgery was 27 and 31 years in Groups 1 and 2, respectively. The proportion of attenuated FAP was significantly lower in Group 2 than in Group 1 (1.0 vs. 13 %, respectively). Pathological examination revealed an increased incidence of malignant polyps in the resected specimens from Group 2 patients (10 vs. 23 %, respectively; P = 0.034). Laparoscopic surgery was more frequent in Group 2 than in Group 1 (61 vs. 40 %, respectively). There was no surgical mortality in either group.
  
  
  CONCLUSIONS
  Prophylactic surgery for FAP results in good short-term surgical outcomes in Japan. The current surgical approach is characterized by limited surgical indications for patients with attenuated FAP, delayed timing of colectomy, and the increasing standardization of laparoscopic surgery.
authors: Department of Surgery, National Defense Medical College, Saitama, Japan.
authors: Masato
authors: M
authors: Yamadera
authors: Department of Surgery, National Defense Medical College, Saitama, Japan. ueno_surg1@ndmc.ac.jp.
authors: Hideki
authors: H
authors: Ueno
authors: Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Hirotoshi
authors: H
authors: Kobayashi
authors: Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: Tsuyoshi
authors: T
authors: Konishi
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
authors: Fumio
authors: F
authors: Ishida
authors: Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors: Tatsuro
authors: T
authors: Yamaguchi
authors: Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors: Takao
authors: T
authors: Hinoi
authors: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.
authors: Yasuhiro
authors: Y
authors: Inoue
authors: Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors: Yukihide
authors: Y
authors: Kanemitsu
authors: Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
authors: Naohiro
authors: N
authors: Tomita
authors: Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors: Hideyuki
authors: H
authors: Ishida
authors: Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors: Kenichi
authors: K
authors: Sugihara
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003082:Colectomy; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D065286:Prophylactic Surgical Procedures; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Familial adenomatous polyposis; Hereditary colorectal cancer; Proctocolectomy; Prophylactic surgery; Total colectomy