Risk of cancer following colectomy with ileorectal/ileosigmoidal anastomosis and proctocolectomy with ileal pouch-anal anastomosis in familial adenomatous polyposis

Aims The aim of this study was to compare the long-term risk of cancer following colectomy with ileorectal/ileosigmoidal anastomosis (IRA/ISA) and proctocolectomy with ileal pouch-anal anastomosis (IPAA) in patients with familial adenomatous polyposis (FAP).

Methods We performed an international multicenter retrospective cohort study of FAP patients undergoing colectomy with IRA/ISA or proctocolectomy with IPAA between 1990 till 2022. The proportion of patients developing cancer following surgery was estimated using the Kaplan Meier method.

Results In total, (procto)colectomy was performed in 588 patients (53.9% female); 309 (52.6%) had IRA/ISA and 279 (47.4%) IPAA. Median age at IRA/ISA and IPAA was 21 and 27 years, and median follow-up 12 and 15 years, respectively. The incidence of cancer following IRA/ISA was 1.9% and 1.1% following IPAA. The cumulative 10- and 20-year cancer free survival rates (IRA/ISA vs IPAA) were 99.0% vs 99.6% and 97.9% vs 99.0%, respectively (log-rank p = 0.32). All patients who developed cancer survived. Endoscopic follow-up data was available in 514 patients (87.4%). The median number of surveillance endoscopies was 11 versus 8 in the IRA/ISA and IPAA group, respectively (p < 0.001). In the IRA/ISA group, the median number of polypectomies was 32 and in the IPAA group 2 (p < 0.001).

Conclusions During the last three decades, the risk of distal cancer after (procto)colectomy in FAP was low. This seems to be the result of appropriate selection of the type and timing of colectomy and frequent endoscopic surveillance including polypectomy.

 

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Conflicts of interest

• Evelien Dekker: endoscopic equipment on loan of FujiFilm and Olympus, research grant from FujiFilm, consultancy for FujiFilm, Olympus, Tillots, GI Supply, CPP-FAP, PAION and Ambu, and speakers' fee from Olympus, Roche, GI Supply, Norgine, IPSEN, PAION and FujiFilm.• Luigi Ricciardiello: consultancy and unrestricted research grant from SLA Pharma AG.• John G. Karstensen: Honorarium from SNIPR BIOME and AMBU and speakers fee from Norgine.• Michal Kaminski: speaker’s fee from Olympus, Fujifilm, Boston Scientific, Medtronic, AlfaSigma, IPSEN, consultancy fee from Olympus, ERBE, AlfaSigma• Francesc Balaguer: Received an honorarium for consultancy from Sysmex and CPP Pharmaceuticals, speaker’s fees from Norgine, and editorial fee from Elsevier• Rodrigo Jover: consultancy for CPP Pharmaceuticals• Barbara A.J. Bastiaansen: speakers' fee from Olympus, Tillotts Pharma AG and Ovesco Endoscopy AG• Maria Pellise: endoscopic equipment on loan of FujiFilm, research grant from FujiFilm, ZiuZ and Casen Recordati, consultancy for FujiFilm, Olympus and speakers' fee from Olympus, Medtronic and FujiFilm

Publication History

Article published online:
14 April 2023