Employing innovation to enhance the safety and reliability of restorative surgical techniques for patients with familial adenomatous polyposis at a national referral centre.

Autor: Alves Martins BA; Department of Colorectal Surgery, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK.; Department of Colorectal Surgery, University Hospital of Brasília, Brasília, Brazil., Shamsiddinova A; Department of Colorectal Surgery, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK.; Department of Surgery and Cancer, Imperial College, London, UK., Worley GHT; Department of Colorectal Surgery, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK., Hsu YJ; Department of Colorectal Surgery, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK.; Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan., Cuthill V; St Mark's Centre for Familial Intestinal Cancer, London North West University Healthcare NHS Trust, London, UK., Hawkins M; St Mark's Centre for Familial Intestinal Cancer, London North West University Healthcare NHS Trust, London, UK., Sinha A; Department of Colorectal Surgery, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK.; Department of Surgery and Cancer, Imperial College, London, UK.; St Mark's Centre for Familial Intestinal Cancer, London North West University Healthcare NHS Trust, London, UK., Jenkins JT; Department of Colorectal Surgery, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK., Miskovic D; Department of Colorectal Surgery, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK., Clark SK; Department of Colorectal Surgery, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK.; Department of Surgery and Cancer, Imperial College, London, UK.; St Mark's Centre for Familial Intestinal Cancer, London North West University Healthcare NHS Trust, London, UK., Faiz OD; Department of Colorectal Surgery, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK. omar.faiz@nhs.net.; Department of Surgery and Cancer, Imperial College, London, UK. omar.faiz@nhs.net.; St Mark's Centre for Familial Intestinal Cancer, London North West University Healthcare NHS Trust, London, UK. omar.faiz@nhs.net.
Jazyk: angličtina
Zdroj: Techniques in coloproctology [Tech Coloproctol] 2024 Nov 09; Vol. 28 (1), pp. 150. Date of Electronic Publication: 2024 Nov 09.
DOI: 10.1007/s10151-024-03021-2
Abstrakt: Introduction: Restorative proctocolectomy (RPC) and total colectomy with ileorectal anastomosis (TC-IRA) are traditional surgical options for individuals with familial adenomatous polyposis (FAP). Re-appraisal and modification to these techniques, such as near-total colectomy with ileo-distal sigmoid anastomosis (NT-IDSA) and RPC with robotic intracorporeal single-stapled anastomosis (RPC-RiSSA), have been implemented in recent years. This study aimed to evaluate the early postoperative outcomes associated with novel techniques employed in a single centre for restorative surgery in patients with FAP.
Methods: A retrospective analysis was conducted using data from patients with FAP who underwent prophylactic restorative surgery between January 2008 and December 2022 at St Mark's Hospital.
Results: Two hundred fifty-three individuals underwent restorative surgery over the 15-year period; 102/253 (40.3%) underwent TC-IRA, 84 (33.2%) had NT-IDSA, and 67 (26.5%) underwent RPC. Laparoscopic approach was the most common (88.2%) operative access. Seventeen patients (6.7%) underwent robotic operations. For robotic-assisted procedures, no conversions were reported. No anastomotic leaks or 30-day reoperations were reported in the NT-IDSA group compared to 8% (0/84 vs 8/102, p = 0.009) and 11% (0/84 vs 11/102, p = 0.002), respectively, in the TC-IRA group. Regarding RPC, following the introduction of robotic RPC-RiSSA in 2019, no anastomotic leakage was observed compared with 9% (0/11 vs 5/56, p = 0.3) in those undergoing conventional RPC.
Conclusion: Our institution has transitioned from TC-IRA to NT-IDSA since 2014 and conventional RPC to RPC-RiSSA in 2019. To date, since refinement of the techniques there have been no anastomotic failures amongst these cohorts. The reported results may offer future horizons for patients undergoing similar procedures for alternative colorectal diseases.
(© 2024. Springer Nature Switzerland AG.)
Databáze: MEDLINE
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