J Korean Surg Soc.  2012 Nov;83(5):288-297. 10.4174/jkss.2012.83.5.288.

Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis

• Kim HJ
• Choi GS
• Park JS
• Park SY
• Choi WH
• Ryuk JP

• KMID: 2145006
• DOI: http://doi.org/10.4174/jkss.2012.83.5.288

Abstract

PURPOSE
We evaluated the short- and long-term outcomes of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC/IPAA) for treatment of familial adenomatous polyposis (FAP). Also, we assessed the oncologic outcomes in FAP patients with coexisting malignancy.
METHODS
From August 1999 to September 2010, 43 FAP patients with or without coexisting malignancy underwent TPC/IPAA by a laparoscopic-assisted or hand-assisted laparoscopic surgery.
RESULTS
The median age was 33 years (range, 18 to 58 years) at the time of operation. IPAA was performed by a hand-sewn method in 21 patients (48.8%). The median operative time was 300 minutes (range, 135 to 610 minutes), which reached a plateau after 22 operations. Early postoperative complications within 30 days occurred in 7 patients (16.3%) and long-term morbidity occurred in 15 patients (34.9%) including 6 (14.0%) with desmoid tumors and 3 (7.0%) who required operative treatment. Twenty-two patients (51.2%) were diagnosed with coexisting colorectal malignancy. The median follow-up was 58.5 months (range, 7.9 to 97.8 months). There was only 1 case of local recurrence in the pelvic cavity. No cases of adenocarcinoma at the residual rectal mucosa developed. 5-year disease-free survival rate for 22 patients who had coexisting malignancy was 86.5% and 5-year overall survival rate was 92.6%. Three patients died from pulmonary or hepatic metastasis.
CONCLUSION
Laparoscopic TPC/IPAA in patients with FAP is feasible and offers favorable postoperative outcomes. It also delivered acceptable oncological outcomes in patients with coexisting malignancy. Therefore, laparoscopic TPC/IPAA may be a favorable treatment option for FAP.

Keyword

Laparoscopic total proctocolectomy; Ileal pouch-anal anastomosis; Familial adenomatous polyposis

MeSH Terms

Adenocarcinoma
Adenomatous Polyposis Coli
Disease-Free Survival
Fibromatosis, Aggressive
Follow-Up Studies
Humans
Mucous Membrane
Operative Time
Postoperative Complications
Recurrence
Survival Rate

Figure

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  Fig. 1 Changes in operative time for laparoscopic total proctocolectomy with ileal pouch-anal anastomosis in the treatment of familial adenomatous polyposis (moving average). The first plateau was observed after 22 cases. Three phases were classified by turning point according to the operative approach or anastomotic methods.

Reference

1. Sampson JR, Dolwani S, Jones S, Eccles D, Ellis A, Evans DG, et al. Autosomal recessive colorectal adenomatous polyposis due to inherited mutations of MYH. Lancet. 2003. 362:39–41.

2. Church JM, McGannon E, Burke C, Clark B. Teenagers with familial adenomatous polyposis: what is their risk for colorectal cancer? Dis Colon Rectum. 2002. 45:887–889.

3. van Duijvendijk P, Slors JF, Taat CW, Oosterveld P, Vasen HF. Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis. Ann Surg. 1999. 230:648–654.

4. Andersson T, Lunde OC, Johnson E, Moum T, Nesbakken A. Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Colorectal Dis. 2011. 13:431–437.

5. Wexner SD, Johansen OB, Nogueras JJ, Jagelman DG. Laparoscopic total abdominal colectomy. A prospective trial. Dis Colon Rectum. 1992. 35:651–655.

6. Schmitt SL, Cohen SM, Wexner SD, Nogueras JJ, Jagelman DG. Does laparoscopic-assisted ileal pouch anal anastomosis reduce the length of hospitalization? Int J Colorectal Dis. 1994. 9:134–137.

7. Marcello PW, Milsom JW, Wong SK, Brady K, Goormastic M, Fazio VW. Laparoscopic total colectomy for acute colitis: a case-control study. Dis Colon Rectum. 2001. 44:1441–1445.

8. Marcello PW, Milsom JW, Wong SK, Hammerhofer KA, Goormastic M, Church JM, et al. Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum. 2000. 43:604–608.

9. Rivadeneira DE, Marcello PW, Roberts PL, Rusin LC, Murray JJ, Coller JA, et al. Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study. Dis Colon Rectum. 2004. 47:1371–1376.

10. Polle SW, van Berge Henegouwen MI, Slors JF, Cuesta MA, Gouma DJ, Bemelman WA. Total laparoscopic restorative proctocolectomy: are there advantages compared with the open and hand-assisted approaches? Dis Colon Rectum. 2008. 51:541–548.

11. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010. 97:1638–1645.

12. Tonelli F, Valanzano R, Monaci I, Mazzoni P, Anastasi A, Ficari F. Restorative proctocolectomy or rectum-preserving surgery in patients with familial adenomatous polyposis: results of a prospective study. World J Surg. 1997. 21:653–658.

13. Knudsen AL, Bisgaard ML, Bulow S. Attenuated familial adenomatous polyposis (AFAP). A review of the literature. Fam Cancer. 2003. 2:43–55.

14. Park IJ, Choi GS, Lim KH, Kang BM, Jun SH. Multidimensional analysis of the learning curve for laparoscopic colorectal surgery: lessons from 1,000 cases of laparoscopic colorectal surgery. Surg Endosc. 2009. 23:839–846.

15. Agha A, Moser C, Iesalnieks I, Piso P, Schlitt HJ. Combination of hand-assisted and laparoscopic proctocolectomy (HALP): Technical aspects, learning curve and early postoperative results. Surg Endosc. 2008. 22:1547–1552.

16. Maartense S, Dunker MS, Slors JF, Cuesta MA, Gouma DJ, van Deventer SJ, et al. Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg. 2004. 240:984–991.

17. Kienle P, Z'graggen K, Schmidt J, Benner A, Weitz J, Büchler MW. Laparoscopic restorative proctocolectomy. Br J Surg. 2005. 92:88–93.

18. Burnstein MJ, Schoetz DJ Jr, Coller JA, Veidenheimer MC. Technique of mesenteric lengthening in ileal reservoir-anal anastomosis. Dis Colon Rectum. 1987. 30:863–866.

19. Cherqui D, Valleur P, Perniceni T, Hautefeuille P. Inferior reach of ileal reservoir in ileoanal anastomosis. Experimental anatomic and angiographic study. Dis Colon Rectum. 1987. 30:365–371.

20. Ziv Y, Fazio VW, Sirimarco MT, Lavery IC, Goldblum JR, Petras RE. Incidence, risk factors, and treatment of dysplasia in the anal transitional zone after ileal pouch-anal anastomosis. Dis Colon Rectum. 1994. 37:1281–1285.

21. Remzi FH, Church JM, Bast J, Lavery IC, Strong SA, Hull TL, et al. Mucosectomy vs. stapled ileal pouch-anal anastomosis in patients with familial adenomatous polyposis: functional outcome and neoplasia control. Dis Colon Rectum. 2001. 44:1590–1596.

22. Heppell J, Weiland LH, Perrault J, Pemberton JH, Telander RL, Beart RW Jr. Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis. Dis Colon Rectum. 1983. 26:768–771.

23. Remzi FH, Fazio VW, Delaney CP, Preen M, Ormsby A, Bast J, et al. Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years. Dis Colon Rectum. 2003. 46:6–13.

24. Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum. 2001. 44:1800–1807.

25. Kienle P, Weitz J, Benner A, Herfarth C, Schmidt J. Laparoscopically assisted colectomy and ileoanal pouch procedure with and without protective ileostomy. Surg Endosc. 2003. 17:716–720.

26. Latchford AR, Sturt NJ, Neale K, Rogers PA, Phillips RK. A 10-year review of surgery for desmoid disease associated with familial adenomatous polyposis. Br J Surg. 2006. 93:1258–1264.

27. Parc Y, Piquard A, Dozois RR, Parc R, Tiret E. Long-term outcome of familial adenomatous polyposis patients after restorative coloproctectomy. Ann Surg. 2004. 239:378–382.

28. Watanabe Y, Sato M, Kikkawa H, Yoshida M, Kusunose H, Kawachi K. Hand-assisted laparoscopic total colorectal resection for familial adenomatous polyposis with coexisting rectal cancer. Surg Endosc. 2001. 15:445–447.