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CC BY-NC-ND 4.0 · Endoscopy 2023; 55(09): 836-846
DOI: 10.1055/a-2038-0541
Original article

Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis

Roshani V. Patel  ‡   ‡
1   Polyposis Registry, St Mark’s Hospital, Harrow, UK
2   Department of Surgery and Cancer, Imperial College London, London, UK
,
Kit Curtius  ‡   ‡
3   Barts Cancer Institute, Queen Mary University of London, London, UK
4   Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California, USA
,
Ripple Man
1   Polyposis Registry, St Mark’s Hospital, Harrow, UK
,
Jordan Fletcher
1   Polyposis Registry, St Mark’s Hospital, Harrow, UK
2   Department of Surgery and Cancer, Imperial College London, London, UK
,
Victoria Cuthill
1   Polyposis Registry, St Mark’s Hospital, Harrow, UK
,
Susan K. Clark
1   Polyposis Registry, St Mark’s Hospital, Harrow, UK
2   Department of Surgery and Cancer, Imperial College London, London, UK
,
Alexander C. von Roon
5   Department of Colorectal Surgery, University College Hospital, London, UK
,
Andrew Latchford 
1   Polyposis Registry, St Mark’s Hospital, Harrow, UK
2   Department of Surgery and Cancer, Imperial College London, London, UK
› Author AffiliationsSupported by: Medical Research Council HDR-UK UKRI Rutherford Fund Fellowship
Supported by: National Institutes of Health P30 CA023100
Supported by: Royal College of Surgeons/Bowel Cancer UK Research fellowship
Supported by: National Institutes of Health P30 CA023100
Supported by: AGA Research Foundation AGA Research Scholar Award AGA2022-13-05
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Abstract

Background Long-term pouch surveillance outcomes for familial adenomatous polyposis (FAP) are unknown. We aimed to quantify surveillance outcomes and to determine which of selected possible predictive factors are associated with pouch dysplasia.

Methods Retrospective analysis of collected data on 249 patients was performed, analyzing potential risk factors for the development of adenomas or advanced lesions ( ≥ 10 mm/high grade dysplasia (HGD)/cancer) in the pouch body and cuff using Cox proportional hazards models. Kaplan–Meier analyses included landmark time-point analyses at 10 years after surgery to predict the future risk of advanced lesions.

Results Of 249 patients, 76 % developed at least one pouch body adenoma, with 16 % developing an advanced pouch body lesion; 18 % developed an advanced cuff lesion. Kaplan–Meier analysis showed a 10-year lag before most advanced lesions developed; cumulative incidence of 2.8 % and 6.4 % at 10 years in the pouch body and cuff, respectively. Landmark analysis suggested the presence of adenomas prior to the 10-year point was associated with subsequent development of advanced lesions in the pouch body (hazard ratio [HR] 4.8, 95 %CI 1.6–14.1; P = 0.004) and cuff (HR 6.8, 95 %CI 2.5–18.3; P < 0.001). There were two HGD and four cancer cases in the cuff and one pouch body cancer; all cases of cancer/HGD that had prior surveillance were preceded by ≥ 10-mm adenomas.

Conclusions Pouch adenoma progression is slow and most advanced lesions occur after 10 years. HGD and cancer were rare events. Pouch phenotype in the first decade is associated with the future risk of developing advanced lesions and may guide personalized surveillance beyond 10 years.

‡ Contributed equally to this article


Tables 1 s–6 s, Fig. 1 s



Publication History

Received: 14 February 2022

Accepted after revision: 15 February 2023

Accepted Manuscript online:
17 February 2023

Article published online:
22 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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