Long-Term Outcome of Patients with Familial Adenomatous Polyposis after Total Colectomy and Ileorectal Anastomosis

Abstract

[Purpose] Total colectomy and ileorectal anastomosis as a prophylactic procedure for patients with familial adenomatous polyposis leaves them a risk of metachronous rectal cancers. The aim of this study is to evaluate the long-term outcome of patients with familial adenomatous polyposis after ileorectal anastomosis. [Methods] Among 28 patients with familial adenomatous polyposis undergoing surgery between 1961 to 2003, 16 underwent ileorectal anastomosis and have been followed up at our hospital by surveillance colonoscopy. We evaluated the incidence of metachronous rectal cancer and extracolonic manifestations, the rate of subsequent proctectomy, and the survival. [Results] The median follow-up time was 13.7 years. Four patients out of 16（ 25％ ） underwent proctectomy and ileal pouch-anal anastomosis for newly developed rectal lesions, at the average age of 59.8 （52–67）, after the average interval period of 17.7 years （14–23.3）. One patient had two advanced cancers after the four-year absence of surveillance colonoscopy. The other three patients, who had been endoscopically followed up every 6 to 12 months regularly, underwent second surgery for small lesions suspected of early cancers. [Conclusion] A life-long regular endoscopic surveillance and adequate treatments for small noninvasive lesions in the residual rectum are important in the management of patients with familial adenomatous polyposis after ileorectal anastomosis.