Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy?

Arquivos de Gastroenterologia

Fábio Guilherme Campos²  Rodrigo Oliva Perez²  Antônio Rocco Imperiale²  Víctor Edmond Seid²  Sérgio Carlos Nahas²  Ivan Cecconello¹ 

[1] ,Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas

关键词: Adenomatous polyposis coli;    Adenomatous polyps;    Colorectal neoplasms;    Proctocolectomy;    restorative;    Anastomosis;    surgical;    Polipose adenomatosa do cólon;    Pólipos adenomatosos;    Neoplasias colorretais;    Proctocolectomia restauradora;    Anastomose cirúrgica;   

DOI  :  10.1590/S0004-28032009000400009

来源: SciELO

【 摘 要 】

CONTEXT: Controversy regarding the best operative choice for familial adenomatous polyposis lays between the morbidity of restorative proctocolectomy and the supposed mortality due to rectal cancer after ileorectal anastomosis. OBJECTIVES: To evaluate operative complications and oncological outcome after ileorectal anastomosis and restorative proctocolectomy. METHODS: Charts from patients treated between 1977 and 2006 were retrospectively analyzed. Clinical and endoscopic data, results of treatment, pathological reports and information regarding early and late outcome were recorded. RESULTS: Eighty-eight patients - 41 men (46.6%) and 47 women (53.4%) - were assisted. At diagnosis, 53 patients (60.2%) already had associated colorectal cancer. Operative complications occurred in 25 patients (29.0 %), being 17 (19.7%) early and 8 (9.3%) late complications. There were more complications after restorative proctocolectomy (48.1%) compared to proctocolectomy with ileostomy (26.6%) and ileorectal anastomosis (19.0%) (P = 0,03). There was no operative mortality. During the follow-up of 36 ileorectal anastomosis, cancer developed in the rectal cuff in six patients (16,6%). Cumulative cancer risk after ileorectal anastomosis was 17.2% at 5 years, 24.1% at 10 years and 43.1% at 15 years of follow-up. Age-dependent cumulative risk started at 30 years (4.3%), went to 9.6% at 40 years, 20.9% at 40 years and 52% at 60 years. Among the 26 patients followed after restorative proctocolectomy, it was found cancer in the ileal pouch in 1 (3.8%). CONCLUSIONS: 1. Operative complications occurred in about one third of the patients, being more frequently after the confection of ileal reservoir; 2. greater age and previous colonic carcinoma were associated with the development of rectal cancer after ileorectal anastomosis; 3. patients treated by restorative proctocolectomy are not free from the risk of pouch degeneration; 4. the disease complexity and the various risk factors (clinical, endoscopic, genetic) indicate that the best choice for operative treatment should be based on individual features discussed by a specialist; 5. all patients require continuous and long-term surveillance during postoperative follow-up.

【 授权许可】

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