Experience with Surgical Treatment for Familial Adenomatous Polyposis (FAP) with Multiple Duodenal Adenomas

Abstract

Here we present the case of a 36-year-old woman who had undergone total colectomy and artificial anus construction for FAP at 20 years of age. She was diagnosed with multiple duodenal adenomas of modified Spigelman classification Stage IV by upper gastrointestinal endoscopy and was referred to our hospital for surgical treatment. We selected pylorus-preserving pancreatoduodenectomy to reduce the risks of occult cancer. Duodenal cancer associated with FAP is considered to be a prognostic factor after colectomy, and the guidelines indicate surgery for tumors classified as Stage IV or higher on the modified Spigelman classification. To date, there is no gold standard for treatment policy for duodenal lesions associated with FAP. Thus, we should consider the risks and benefits of surgery with careful preoperative diagnosis.