Dispelling misconceptions in the management of familial adenomatous polyposis

Abstract

Patients with familial adenomatous polyposis require surgical intervention at some point in their lives. The diagnosis is often apparent from their phenotype and family history, however, this is not always the case. Many factors can influence the surgical strategy although the polyposis burden and distribution remain the main consideration. While prophylactic removal of the rectum and colon is often required, sparing the rectum at the index surgery is safe in select patients. This article aims to dispel misconceptions in the diagnosis and treatment of patients with familial adenomatous polyposis.

Risk of desmoid formation after laparoscopic versus open colectomy and ileorectal anastomosis for familial adenomatous polyposis

“…Analysis of a cohort from the Cleveland Clinic demonstrated that the risk of desmoid development after IRA was less than that of patients undergoing RPC 11 . In the IRA group, a laparoscopic approach at surgery was associated with a lower risk of desmoid development than an open approach.…”

Management of patients with polyposis

“…As the 70th anniversary approaches of the first subtotal colectomy and ileo‐rectal anastomosis (performed at St. Mark's Hospital, London, in 1948), the paper by Chittleborough et al . updates us on five issues relating to the surgical management of patients with familial adenomatous polyposis (FAP).…”

“…Both groups may not keep up to date with advances, such as those presented at the biennial scientific meeting of the International Society for Gastrointestinal Hereditary Tumours (InSiGHT, http://www.insight-group.org). This multidisciplinary meeting is marked by the presence of senior colorectal surgeons, such as the international co‐authors of the paper by Chittleborough et al . While other centres of excellence and hereditary cancer registries are also amply represented at the InSiGHT meetings, they represent a tiny percentage of the total number of colorectal specialists who treat these patients.…”

“…Chittleborough et al . discuss several issues in some depth in order to educate a broader surgical cohort, but the surface is only scratched with regard to the complexities and challenges of this condition.…”

“…Our health system is not optimally designed to take advantage of this opportunity, which is presumably why the authors perceived a need to clarify at least a limited number of issues. That is a pragmatic approach; more effective in the long term perhaps would be an initiative whereby consensus could be reached as to which centres could be designated ‘excellent’, and which surgeons and others and teams could be credentialled and regularly accredited as being up to the mark as subspecialists in this area.…”