Alimentary TractIleorectal anastomosis is appropriate for a subset of patients with familial adenomatous polyposis☆
Section snippets
Materials and methods
The national polyposis registries of Denmark, Finland, Holland, and Sweden were searched for patients undergoing surgery from January 1, 1940, to December 31, 1997, with a colectomy and an ileorectal anastomosis as the primary procedure. Patients in regular followup with at least one annual proctoscopy were included in the study.
The registered data included date of birth, sex, proband/call-up case, familial/isolated case, location of mutation in the apc gene, date of IRA, colon cancer at IRA,
Results
The study consisted of 659 patients, 349 men (53%) and 310 women, from Denmark (126), Finland (105), Holland (240), and Sweden (188). The median age at IRA was 26 years (range, 7–75 years). Of them, 193 were probands (29%) and 418 (63%) were call-up patients, and the status proband/call-up case was unknown in 48 patients. Seventy-five patients (11%) were isolated cases with no family history of FAP. The specific apc gene mutation was known in 167 of 366 (46%) Dutch and Danish patients (Figure
Discussion
The choice of surgical method in FAP has remained controversial over the past 30 years, primarily because of different results on the long-term risk of secondary rectal cancer. The first surgical method was total proctocolectomy with ileostomy, which was gradually replaced by colectomy and IRA during the 1940s. IRA is a one-step procedure with almost no mortality, low postoperative morbidity, and good functional results, but the patients are left with their rectum in situ, and the risk of
Acknowledgements
The authors gratefully acknowledge the work of Dr. Carli Tops.
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Address requests for reprints to: Steffen Bülow, M.D., D.M.Sc., The Danish Polyposis Register, Department of Surgical Gastroenterology 435, Hvidovre University Hospital, DK-2650 Hvidovre, Copenhagen, Denmark. e-mail: [email protected]; fax: (45) 3632-3200.