Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis
| Autor: | Paul Oosterveld, J. Frederik M. Slors, Peter van Duijvendijk, Hans F. A. Vasen, C. W. Taat |
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| Rok vydání: | 1999 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Colorectal cancer medicine.medical_treatment Rectum Anastomosis Familial adenomatous polyposis Neoplasms Multiple Primary Surgical anastomosis Surveys and Questionnaires medicine Humans Colectomy Laparotomy business.industry Proctocolectomy General surgery Proctocolectomy Restorative Original Articles medicine.disease Surgery medicine.anatomical_structure Treatment Outcome Adenomatous Polyposis Coli Female Pouch business Colorectal Neoplasms |
| Zdroj: | Annals of surgery. 230(5) |
| ISSN: | 0003-4932 |
| Popis: | Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disease caused by mutations at the APC gene on chromosome 5. The disease is characterized by hundreds of adenomatous polyps in the colon and rectum. In most patients, polyps develop during the second and third decade of life. Without timely surgical intervention, colorectal cancer will develop in virtually all patients. 1 Although several studies have shown that chemoprevention has some beneficial effect on the colorectal adenomas, the only curative treatment is still surgical. The two main surgical options are colectomy with an ileorectal anastomosis (IRA) 2 or a restorative proctocolectomy with an ileal pouch–anal anastomosis (IPAA). IRA has the advantage both of a low complication rate and of good functional results with regard to stool frequency, continence, and soiling. However, even after close monitoring, the cumulative risk of cancer evolving in the rectal stump is reported to be 15% after 25 years of follow-up. 3–6 In addition, many patients with an IRA need a secondary proctocolectomy because of uncontrollable polyps. 6 Restorative proctocolectomy and IPAA eradicate virtually all of the colonic mucosa, thereby eliminating the risk for cancer 7–9; it may therefore be the preferred treatment. However, IPAA also has some disadvantages, such as its greater technical complexity and the incidental need to construct a temporary diverting ileostomy, which then requires a second operation for removal. 10 In addition, the complication rate is higher, and there is a not insignificant risk that pouch removal may become necessary due to complication or malfunction. 11,12 Moreover, several short-term studies have reported functional results to be less satisfactory than those after IRA. 13–17 Some reports have also claimed that functional results after an IPAA are decreased if a mucosectomy is performed. 18–20 The fact that many patients need a secondary proctectomy after IRA might constitute a strong argument in favor of performing an IPAA as the primary surgical procedure. Only if the functional outcome of IRA is better than that of IPAA is there still a place for IRA, although this would represent a temporary solution for many patients with FAP. The aim of the present study, therefore, was to evaluate the possible difference in functional outcome in a large series of patients who had undergone either of the procedures. In addition, the different roles played by comorbidity, age, coexistence of colorectal carcinoma, incidence of relaparotomy, conversion of IRA to IPAA, and anastomotic technique in IPAA on functional outcome were also assessed. |
| Databáze: | OpenAIRE |
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