Familial polyposis of the colon with special reference to regression of rectal polyposis after subtotal colectomy

Abstract

Two families with familial polyposis of the colon are reported. One family conforms to the established pattern and in the other there is a risk of an additional inheritance of sebaceous cysts and fibromata. Initially prophylactic surgery should usually consist of a one‐stage subtotal colectomy with ileorectal anastomosis. Thereafter the polyps in the rectal remnant are left untreated for 6 months in the hope of spontaneous regression of some years' duration. This routine is preferable to immediate total colectomy and ileostomy for the adolescent or young adult. Fulguration of residual polyps is deferred but may be necessary if there is no spontaneous regression. A second‐stage excision may be required if polyposis becomes uncontrollable or if there is malignant change. A case may be made for prophylactic rectal excision about 10 years after subtotal colectomy. The technique of ileorectal anastomosis is discussed briefly and a plan for family supervision is outlined. It is suggested that the phenomenon of spontaneous regression of polyps in the rectal remnant may be more frequent than accepted at present and that a long‐term follow‐up of patients with regression is required.

Regular endoscopic surveillance and polypectomy is effective in managing rectal adenoma progression following colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis

“…They include: (1) removal of the colon is thought to induce changes in the faecal microbiota and bile acid content which affects rectal mucosal proliferation and polyp development and (2) increased alkalinity in the ileal content destroys polyps in the rectum [19]. Our results did not show convincing evidence of polyp regression.…”

“…As a result, recent guidelines on preoperative surveillance of the colorectum in FAP suggest a role for individualising the frequency of surveillance based on the patient's genotype and phenotype [17]. Furthermore, historical studies have suggested spontaneous regression in adenoma count can occur after TC-IRA [18,19]. Understanding the rate of adenoma progression or regression and the role of therapeutic procedures such as cold snare polypectomy in management of rectal polyposis will help inform surveillance planning and surgical decision making.…”

Rectocolic familial polyposis; a study of 32 cases

“…The Future of the Preserved Rectum. Apart from the spontaneous regression of the adenomata in the rectum after a colectomy [11,[18][19][20][21]--a phenomenon difficult to explain but of limited interest, since it is both partial and temporary--the attention must be directed toward the risk of a later cancerization.…”

Spontaneous regression of rectal polyps following abdominal colectomy and ileorectal anastomosis for familial adenomatous polyposis, without sulindac treatment: Report of four cases

“…However, the effects of long−term sulindac therapy are still unknown and up− per gastrointestinal side effects (gastrointestinal erosions or bloating) have been reported after prolonged treatment. Spontaneous resolution of rectal polyps after colectomy and ileorectal anastomosis alone has been reported to occur [10]. Colectomy is a known factor in decreasing colonic and rectal mucosal proliferation and can by itself lead to polyp regression.…”