Impact of Surgery on the Development of Duodenal Cancer in Patients with Familial Adenomatous Polyposis
| Autor: | Gilberto Poggioli, Elisabetta Nobili, M. Ponz de Leon, T. Venesio, Guido Biasco, Giovanni Brandi, G. Di Febo, G. Bertoni, Mauro Risio, Maria Abbondanza Pantaleo, Lorenzo Camellini, G. Bedogni, A. De Vivo, Liliana Varesco, Carlo Calabrese, Romano Sassatelli |
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| Přispěvatelé: | Biasco G, Nobili E, Calabrese C, Sassatelli R, Camellini L, Pantaleo MA, Bertoni G, De Vivo A, Ponz De Leon M, Poggioli G, Bedogni G, Venesio T, Varesco L, Risio M, Di Febo G, Brandi G. |
| Rok vydání: | 2006 |
| Předmět: |
Adenoma
Adult Male medicine.medical_specialty Duodenal cancer Familial adenomatous polyposis Spigelman score Ileoanal anastomosis Ileorectal anastomosis Ileostomy medicine.medical_treatment Anal Canal Gastroenterology Duodenal Neoplasms Ileum Internal medicine Humans Medicine Prospective Studies Duodenoscopy Germ-Line Mutation Colectomy business.industry Proctocolectomy Anastomosis Surgical Proctocolectomy Restorative Rectum Cancer General Medicine medicine.disease Colorectal surgery Surgery medicine.anatomical_structure Adenomatous Polyposis Coli Duodenum Female business Precancerous Conditions Follow-Up Studies |
| Zdroj: | Diseases of the Colon & Rectum. 49:1860-1866 |
| ISSN: | 0012-3706 |
| DOI: | 10.1007/s10350-006-0723-y |
| Popis: | Precancerous duodenal lesions in patients with familial adenomatous polyposis can be detected with duodenoscopy and treatment may prevent the development of cancer. We proposed to determine the frequency, natural history, cumulative risk, and risk factors of the precancerous duodenal lesions in a series of patients diagnosed in northern Italy. METHODS: A prospective, endoscopic, follow-up protocol was performed in 50 patients examined by gastroduodenoscopy at two years of interval or less. The presence and severity of precancerous lesions of the duodenal mucosa were evaluated by Spigelman score. Twenty-five patients (50 percent) had proctocolectomy and ileoanal anastomosis, 15 (30 percent) had colectomy and ileorectal anastomosis, and 5 (10 percent) had proctocolectomy and definitive ileostomy from 0 to 3 years before the admission to the surveillance program. All patients showed more than a thousand adenomas in the colorectal mucosa. No patients with attenuated polyposis were found. RESULTS: At the first endoscopy, duodenal adenomas could be detected in 19 of 50 patients (38 percent), whereas at the end of the follow-up, 43 (86 percent) had duodenal lesions. The final mean Spigelman score increased during the follow-up period (P < 0.001 respect to baseline values). No duodenal cancer could be detected. Eleven patients had or developed severe precancerous duodenal lesions (Stage IV) treated with endoscopic or surgical resection. The istribution of patients with Stage IV according to the surgery of the colon was: 2 of 25 treated with ileoanal anastomosis and 8 of 15 with ileorectal anastomosis (P = 0.0024, Fisher_s exact test). CONCLUSIONS: Patients with familial adenomatous polyposis are at risk of significant neoplasia. The natural history of precancerous lesions might be related to surgical treatment of colorectal neoplasms. |
| Databáze: | OpenAIRE |
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