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. 2015 May;27(4):471-478.
doi: 10.1111/den.12414. Epub 2015 Jan 16.

Risk of cancer in the rectal remnant after ileorectal anastomosis in patients with familial adenomatous polyposis: single center experience

Yuji Maehata  1 , Motohiro Esaki  1 , Shotaro Nakamura  2 , Minako Hirahashi  3 , Takashi Ueki  4 , Mitsuo Iida  5 , Takanari Kitazono  1 , Takayuki Matsumoto  2
Affiliations

Risk of cancer in the rectal remnant after ileorectal anastomosis in patients with familial adenomatous polyposis: single center experience

Yuji Maehata et al. Dig Endosc. 2015 May.

Abstract

Background and aim: We aimed to evaluate the long-term risk of cancer in the rectal remnant in patients with familial adenomatous polyposis after ileorectal anastomosis.

Methods: Cumulative incidence and clinicopathological characteristics of cancer in the rectal remnant were retrospectively investigated in 27 patients with familial adenomatous polyposis who had undergone ileorectal anastomosis.

Results: During the follow-up period ranging from 3.0 to 35.0 years (median, 21.1 years), cancer in the rectal remnant developed in 10 patients. Cumulative risk of cancer in the rectal remnant 30 years after surgery was 57%. Five patients had metastases and three patients died of cancer in the rectal remnant after proctectomy. There was a trend towards a higher incidence of cancer in the rectal remnant in patients with small-intestinal adenoma and congenital hypertrophy of the retinal pigment epithelium. Multivariate analysis revealed that the ocular lesion was an independent risk factor associated with cancer in the rectal remnant.

Conclusion: Subtotal colectomy with ileorectal anastomosis does not seem to be an appropriate prophylactic surgery in patients with familial adenomatous polyposis.

Keywords: cancer in the rectal remnant; congenital hypertrophy of the retinal pigment epithelium; familial adenomatous polyposis; ileal pouch-anal anastomosis; ileorectal anastomosis.

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