Abstracts
2000 Digestive Disease Week

# 2394 Decision Analysis in the Surgical Treatment of Familial Adenomatous Polyposis: A Dutch-Scandinavian Collaborative Study.
Hans F A Vasen, Peter Duijvendijk, Charlotte Bulow, Jan Bjork, Heiki Jarvinnen, Steffen Bulow, Amsterdam, Netherlands, Copenhagen, Denmark, Helsinki, Finland, Leiden, Netherlands, Lund, Sweden

Introduction: The choice of surgery in patients with familial adenomatous polyposis lies between the morbidity of proctocolectomy and ileum-pouchanal anastomosis (IPAA) and the risk of dying from rectal cancer after colectomy and ileorectal anastomosis (IRA). Most studies so far focused on assessment of the risk of developing rectal cancer after IRA and not on evaluation of the risk of dying from this cancer. The aims of the present study were, therefore, (1) to assess the risk of dying from rectal cancer, (2) to investigate whether regular endoscopic examination leads to detection of rectal cancer at an earlier stage and, (3) to compare the life expectancy between patients with an IRA and those with an IPAA. Patients and Methods: Clinical and pathological data on 659 patients were collected from four National Polyposis Registries, i.e., in Denmark, Finland, Sweden and Holland. The data were analyzed using survival analysis methods. Decision analysis was used to compare the life expectancy between patients with an IRA and IPAA. Results: A total of 47 patients developed rectal cancer after IRA. The risk of dying from rectal cancer was eleven percent by age 65. Compared to IRA, IPAA would lead to an increase in life expectancy of about 1.5 years. Seventy- five percent of the patients with rectal cancer had a previous negative proctoscopy within 12 month before the diagnosis. Conclusion: The study indicates that IRA is associated with a significant risk of death due to rectal cancer and that death can not be prevented by endoscopic follow up of the rectum.