1998 Abstract: THE CUMULATIVE RISK OF DEVELOPING POLYPS OR MALIGNANCY AT THE ILEO-POUCH-ANAL ANASTO-MOSIS IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS (FAP). P. van Duijvendijk1, J.F.M. Slors1, C.W. Taat1, S. Bülow2, L. Bertario3, J.H.C. Kuijpers4, W.R. Schouten5, J.G. Guillem6 H.F.A. Vasen7, Dept. of Surgery, Academic Medical Centre Amsterdam1, Danish Polyposis Registry2, Italian Registry of Familial Polyposis3, Dept. of Surgery, University Hospital Nijmegen4, Dept. of Surgery, University Hospital Rotterdam5, Memorial Sloan-Kettering Cancer Center, New York6, The Netherlands Foundation for the Detection of Hereditary Tumours7. 42
Abstracts 1998 Digestive Disease Week
#2333
THE CUMULATIVE RISK OF DEVELOPING POLYPS OR MALIGNANCY AT THE ILEO-POUCH-ANAL ANASTO-MOSIS IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS (FAP). P. van Duijvendijk1, J.F.M. Slors1, C.W. Taat1, S. Bülow2, L. Bertario3, J.H.C. Kuijpers4, W.R. Schouten5, J.G. Guillem6 H.F.A. Vasen7, Dept. of Surgery, Academic Medical Centre Amsterdam1, Danish Polyposis Registry2, Italian Registry of Familial Polyposis3, Dept. of Surgery, University Hospital Nijmegen4, Dept. of Surgery, University Hospital Rotterdam5, Memorial Sloan-Kettering Cancer Center, New York6, The Netherlands Foundation for the Detection of Hereditary Tumours7.
In FAP patients restorative proctocolectomy (RPC) is thought to abolish the risk of colorectal adenoma development. However adenomas have been reported at the ileo-anal anastomosis. Patients with either a double stapled anastomosis or a hand-sewn anastomosis with mucosectomy to the dentate line are at risk for developing new polyps at the ileo-anal anastomosis. Purpose: To evaluate the overall cumulative risk of developing adenomatous polyps after both techniques and to evaluate if there is any difference in the incidence between both groups. Methods: 115 consecutive FAP patients undergoing a RPC were identified from Registries in The Netherlands, Denmark, Italy, Germany and New York. Results: Life table analysis was used to calculate the cumulative risk for developing polyps in eighty-six patients. They had at least one year endoscopic follow-up (mean 54.9 ± 40.6 months). A double stapled anastomosis was used in thirty-three patients, whereas in fifty-three patients a hand-sewn anastomosis was performed. In 13 patients polyps had developed at the anastomotic site, one showed severe and three showed moderate dysplasia. None developed a carcinoma. The cumulative risk for developing a polyp at the anastomotic site was 11.5% (95% C.I. 5.7-17.3%) at 3.5 years and 19.9% (95% C.I. 9.3-30.5%) at 7 years, respectively. The risk for developing a new polyp at the anastomotic site within 7 years was 37.6% for patients with a double stapled anastomosis versus 8.3% for patients with a hand-sewn anastomosis with mucosectomy (p < 0.01 (log-rank test)). Conclusion: Since FAP patients undergoing a RPC with either a double stapled or a hand-sewn anastomosis have a substantial risk for developing adenomatous polyps at the anastomotic site, lifelong endoscopic surveillance is mandatory in both groups.
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