Surgical outcomes of laparoscopic colorectal resections for familial adenomatous polyposis

Abstract

Background: Acceptance of extended laparoscopic colon resections is still controversial besides the growing experience over the years.

Aim: The aim of this study was to evaluate the postoperative outcomes of laparoscopic colorectal resections exclusively for familial adenomatous polyposis patients.

Methods: Patient data, surgical procedures and operative outcomes from 49 patients submitted to total proctocolectomy (TPC) or total abdominal colectomy (TAC) from 1997 to 2009 were prospectively analyzed.

Results: There were 18 (36.7%) men and 31 (63.3%) women, with a median age of 31.1 years. Surgical procedures consisted of 3 TPC with ileostomy (6.1%), 30 restorative TPC with ileoanal anastomosis (61.2%), and 16 TAC with ileorectal anastomosis (32.6%). Only 1 patient (2.0%) required open conversion. No patient required blood transfusion. Median operating time was 289, ranging from 150 to 400 minutes. Twelve patients (24.5%) presented complications and only 1 (2.0%) died. Overall complication rates were similar after TAC or TPC (31.2% vs. 21.2%; P=0.4). Reoperations were necessary in 7 cases (14.3%), and the median length of hospital stay was 6.2 days (3 to 16). The comparison of 2 consecutive groups of patients over time revealed a little improvement in surgery duration (301 to 276 min; P=0.16), but relevant reduction in morbidity (32% vs. 16.6%; P=0.2) and reoperation rates (20% vs. 8.3%; P=0.4), besides the absence of statistical difference.

Conclusions: Laparoscopic TPC and TAC represent an interesting alternative approach for young and motivated familial adenomatous polyposis patients. When performed by experienced surgeons, they provide excellent short-term outcome regarding immediate recovery, morbidity, and cosmesis.