Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients
Autor: | Jan Björk, P. van Duijvendijk, Heikki Järvinen, Charlotte Bülow, Hans F. A. Vasen, Steffen Bülow, Erik Buskens |
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Rok vydání: | 2001 |
Předmět: |
Adult
Male medicine.medical_specialty Colorectal cancer medicine.medical_treatment Rectum Article Decision Support Techniques Familial adenomatous polyposis Ileum medicine Humans Registries Sigmoidoscopy Colectomy Aged Aged 80 and over medicine.diagnostic_test business.industry Proctocolectomy Patient Selection General surgery Anastomosis Surgical Proctocolectomy Restorative Gastroenterology Cancer Middle Aged medicine.disease Colorectal surgery Surgery medicine.anatomical_structure Adenomatous Polyposis Coli Female Epidemiologic Methods business |
Zdroj: | Gut. 49:231-235 |
ISSN: | 1468-3288 0017-5749 |
Popis: | BACKGROUND AND AIMSThe choice of colorectal surgery in patients with familial adenomatous polyposis lies between the morbidity of proctocolectomy and ileum-pouch-anal anastomosis (IPAA) and the mortality from rectal cancer after total colectomy and ileorectal anastomosis (IRA). The aims of the present study were: (1) to assess the risk of dying from rectal cancer after IRA, (2) to compare the life expectancy between patients with an IRA and those with an IPAA, and (3) to investigate whether regular endoscopic examination of the rectum leads to detection of cancer at an earlier stage.METHODSClinical and pathological data on 659 patients who underwent colectomy and ileorectal anastomosis were collected from four national polyposis registries—that is, in Denmark, Finland, Sweden, and the Netherlands. Data were analysed using survival analysis methods. Decision analysis was used to compare the life expectancy between patients with an IRA and those with an IPAA.RESULTSA total of 47 patients developed rectal cancer after IRA. The risk of dying from rectal cancer was 12.5% (95% confidence interval 7.1–17.9%) by age 65. Compared with IRA, IPAA would lead to an increase in life expectancy of 1.8 years. Seventy five per cent of patients with rectal cancer had a negative rectoscopy within 12 months before the diagnosis.CONCLUSIONIRA is associated with substantial mortality due to rectal cancer. Follow up examinations of the rectum does not have sufficient preventive effect on morbidity and mortality of rectal cancer. |
Databáze: | OpenAIRE |
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