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Does ileoanal pouch surgery increase the risk of desmoid in patients with familial adenomatous polyposis?

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Abstract

Purpose

Patients with familial adenomatous polyposis (FAP) may undergo either ileorectal anastomosis (IRA) or ileal pouch anal anastomosis (IPAA) depending on the degree of rectal involvement. Desmoid tumors (DTs) may arise postoperatively. Whether IPAA is associated with a higher risk of DTs as compared with IRA remains controversial. The purpose of this study was to determine whether IPAA increased the risk of DTs by analyzing the published data that compared IRA and IPAA as the primary treatment for FAP.

Methods

A metaanalysis was performed to analyze the published data between 1989 and 2019. IRA and IPAA were compared with respect to the incidence of DTs.

Results

Eight retrospective studies with a total of 1072 patients were identified: 491 underwent IPAA and 581 IRA. There was no significant difference in the incidence of DTs between IPAA and IRA (11.81% vs. 9.47%, OR 0.95, P = 0.85). Meanwhile, the overall complication (42.97% vs. 36.76%, OR 1.32, P = 0.11), incidence of cancer (4.88% vs. 8.37%, OR 0.28, P = 0.26), and overall mortality (0.33% vs. 5.20%, OR 0.49, P = 0.53) were comparable too.

Conclusion

Ileoanal pouch surgery is associated with similar risk of desmoid in patients with FAP after surgery.

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References

  1. Kinzler KW, Nilbert MC, Vogelstein B, Bryan TM, Levy DB, Smith KJ, Preisinger AC, Hamilton SR, Hedge P, Markham A (1991) Identification of a gene located at chromosome 5q21 that is mutated in colorectal cancers. Science 251:1366-1370. https://doi.org/10.1126/science.1848370

    Article  CAS  PubMed  Google Scholar 

  2. Giardiello FM, Brensinger JD, Petersen GM, Luce MC, Hylind LM, Bacon JA, Booker SV, Parker RD, Hamilton SR (1997) The use and interpretation of commercial APC gene testing for familial adenomatous polyposis. N Engl J Med 336:823-827. https://doi.org/10.1056/NEJM199703203361202

    Article  CAS  PubMed  Google Scholar 

  3. Rabelo R, Foulkes W, Gordon PH, Wong N, Yuan ZQ, MacNamara E, Chong G, Pinsky L, Lasko D (2001) Role of molecular diagnostic testing in familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer families. Dis Colon Rectum 44:437-446. https://doi.org/10.1007/bf02234746

    Article  CAS  PubMed  Google Scholar 

  4. Half E, Bercovich D, Rozen P (2009) Familial adenomatous polyposis. Orphanet J Rare Dis 4:22. https://doi.org/10.1186/1750-1172-4-22

    Article  PubMed  PubMed Central  Google Scholar 

  5. Melnitchouk N, Saadat LV, Bleday R, Goldberg JE (2019) A decision analysis for rectal-sparing familial adenomatous polyposis: total colectomy with ileorectal anastomosis versus proctocolectomy with IPAA. Dis Colon Rectum 62:27-32. https://doi.org/10.1097/DCR.0000000000001186

    Article  PubMed  Google Scholar 

  6. Campos FG (2014) Surgical treatment of familial adenomatous polyposis: dilemmas and current recommendations. World J Gastroenterol 20:16620-16629. https://doi.org/10.3748/wjg.v20.i44.16620

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tudyka VN, Clark SK (2012) Surgical treatment in familial adenomatous polyposis. Ann Gastroenterol 25:201-206. https://doi.org/10.1007/s003840050034

    Article  PubMed  PubMed Central  Google Scholar 

  8. Heiskanen I, Jarvinen HJ (1996) Occurrence of desmoid tumours in familial adenomatous polyposis and results of treatment. Int J Color Dis 11:157-162. https://doi.org/10.1007/s003840050034

    Article  CAS  Google Scholar 

  9. Sinha A, Tekkis PP, Neale KF, Phillips RK, Clark SK (2010) Risk factors predicting intra-abdominal desmoids in familial adenomatous polyposis: a single centre experience. Tech Coloproctol 14:141-146. https://doi.org/10.1007/s10151-010-0573-4

    Article  CAS  PubMed  Google Scholar 

  10. Hartley JE, Church JM, Gupta S, McGannon E, Fazio VW (2004) Significance of incidental desmoids identified during surgery for familial adenomatous polyposis. Dis Colon Rectum 47:334-340. https://doi.org/10.1007/s10350-003-0063-0

    Article  CAS  PubMed  Google Scholar 

  11. Slowik V, Attard T, Dai H, Shah R, Septer S (2015) Desmoid tumors complicating familial adenomatous polyposis: a meta-analysis mutation spectrum of affected individuals. BMC Gastroenterol 15:84. https://doi.org/10.1186/s12876-015-0306-2

    Article  PubMed  PubMed Central  Google Scholar 

  12. Konishi T, Ishida H, Ueno H, Kobayashi H, Hinoi T, Inoue Y, Ishida F, Kanemitsu Y, Yamaguchi T, Tomita N, Matsubara N, Watanabe T, Sugihara K (2016) Feasibility of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis and total colectomy with ileorectal anastomosis for familial adenomatous polyposis: results of a nationwide multicenter study. Int J Clin Oncol 21:953-961. https://doi.org/10.1007/s10147-016-0977-x

    Article  PubMed  Google Scholar 

  13. Vitellaro M, Bonfanti G, Sala P, Poiasina E, Barisella M, Signoroni S, Mancini A, Bertario L (2011) Laparoscopic colectomy and restorative proctocolectomy for familial adenomatous polyposis. Surg Endosc 25:1866-1875. https://doi.org/10.1007/s00464-010-1478-z

    Article  PubMed  Google Scholar 

  14. Soravia C, Klein L, Berk T, O'Connor BI, Cohen Z, McLeod RS (1999) Comparison of ileal pouch-anal anastomosis and ileorectal anastomosis in patients with familial adenomatous polyposis. Dis Colon Rectum 42:1028-1034. https://doi.org/10.1007/bf02236696

    Article  CAS  PubMed  Google Scholar 

  15. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603-605. https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  16. Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719-748

    CAS  PubMed  Google Scholar 

  17. Egger M, Davey SG, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629-634. https://doi.org/10.1136/bmj.315.7109.629

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177-188. https://doi.org/10.1016/j.cct.2015.09.002

    Article  CAS  PubMed  Google Scholar 

  19. Tonelli F, Valanzano R, Monaci I, Mazzoni P, Anastasi A, Ficari F (1997) Restorative proctocolectomy or rectum-preserving surgery in patients with familial adenomatous polyposis: results of a prospective study. World J Surg 21:653-659. https://doi.org/10.1007/s002689900289

    Article  CAS  PubMed  Google Scholar 

  20. van Duijvendijk P, Slors JF, Taat CW, Oosterveld P, Vasen HF (1999) Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis. Ann Surg 230:648-654. https://doi.org/10.1097/00000658-199911000-00006

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bjork J, Akerbrant H, Iselius L, Svenberg T, Oresland T, Pahlman L, Hultcrantz R (2001) Outcome of primary and secondary ileal pouch-anal anastomosis and ileorectal anastomosis in patients with familial adenomatous polyposis. Dis Colon Rectum 44:984-992. https://doi.org/10.1007/bf02235487

    Article  CAS  PubMed  Google Scholar 

  22. Booij KA, Mathus-Vliegen EM, Taminiau JA, Ten KF, Slors JF, Tabbers MM, Aronson DC (2010) Evaluation of 28 years of surgical treatment of children and young adults with familial adenomatous polyposis. J Pediatr Surg 45:525-532. https://doi.org/10.1016/j.jpedsurg.2009.06.017

    Article  PubMed  Google Scholar 

  23. Koskenvuo L, Mustonen H, Renkonen-Sinisalo L, Jarvinen HJ, Lepisto A (2015) Comparison of proctocolectomy and ileal pouch-anal anastomosis to colectomy and ileorectal anastomosis in familial adenomatous polyposis. Familial Cancer 14:221-227. https://doi.org/10.1007/s10689-014-9773-9

    Article  CAS  PubMed  Google Scholar 

  24. Penna C, Tiret E, Parc R, Sfairi A, Kartheuser A, Hannoun L, Nordlinger B (1993) Operation and abdominal desmoid tumors in familial adenomatous polyposis. Surg Gynecol Obstet 177:263-268

    CAS  PubMed  Google Scholar 

  25. Jones IT, Jagelman DG, Fazio VW, Lavery IC, Weakley FL, McGannon E (1986) Desmoid tumors in familial polyposis coli. Ann Surg 204:94-97. https://doi.org/10.1097/00000658-198607000-00014

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Mastoraki A, Schizas D, Vergadis C, Naar L, Strimpakos A, Vailas MG, Hasemaki N, Agrogiannis G, Liakakos T, Arkadopoulos N (2019) Recurrent aggressive mesenteric desmoid tumor successfully treated with sorafenib: a case report and literature review. World J Clin Oncol 10:183-191. https://doi.org/10.5306/wjco.v10.i4.183

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bertario L, Russo A, Sala P, Eboli M, Giarola M, D'Amico F, Gismondi V, Varesco L, Pierotti MA, Radice P (2001) Genotype and phenotype factors as determinants of desmoid tumors in patients with familial adenomatous polyposis. Int J Cancer 95:102-107. https://doi.org/10.1002/1097-0215(20010320)95:2<102::aid-ijc1018>3.0.co;2-8

    Article  CAS  PubMed  Google Scholar 

  28. Vasen HF, Moslein G, Alonso A, Aretz S, Bernstein I, Bertario L, Blanco I, Bulow S, Burn J, Capella G, Colas C, Engel C, Frayling I, Friedl W, Hes FJ, Hodgson S, Jarvinen H, Mecklin JP, Moller P, Myrhoi T, Nagengast FM, Parc Y, Phillips R, Clark SK, de Leon MP, Renkonen-Sinisalo L, Sampson JR, Stormorken A, Tejpar S, Thomas HJ, Wijnen J (2008) Guidelines for the clinical management of familial adenomatous polyposis (FAP). Gut 57:704-713. https://doi.org/10.1136/gut.2007.136127

    Article  CAS  PubMed  Google Scholar 

  29. Howard JH, Pollock RE (2016) Intra-abdominal and abdominal wall desmoid fibromatosis. Oncol Ther 4:57-72. https://doi.org/10.1007/s40487-016-0017-z

    Article  PubMed  Google Scholar 

  30. Enzo MV, Rastrelli M, Rossi CR, Hladnik U, Segat D (2015) The Wnt/beta-catenin pathway in human fibrotic-like diseases and its eligibility as a therapeutic target. Mol Cell Ther 3:1. https://doi.org/10.1186/s40591-015-0038-2

    Article  PubMed  PubMed Central  Google Scholar 

  31. Carothers AM, Rizvi H, Hasson RM, Heit YI, Davids JS, Bertagnolli MM, Cho NL (2012) Mesenchymal stromal cell mutations and wound healing contribute to the etiology of desmoid tumors. Cancer Res 72:346-355. https://doi.org/10.1158/0008-5472.CAN-11-2819

    Article  CAS  PubMed  Google Scholar 

  32. Klemmer S, Pascoe L, DeCosse J (1987) Occurrence of desmoids in patients with familial adenomatous polyposis of the colon. Am J Med Genet 28:385-392. https://doi.org/10.1002/ajmg.1320280217

    Article  CAS  PubMed  Google Scholar 

  33. Tonelli F, Valanzano R, Brandi ML (1994) Pharmacologic treatment of desmoid tumors in familial adenomatous polyposis: results of an in vitro study. Surgery 115:473-479

    CAS  PubMed  Google Scholar 

  34. Elayi E, Manilich E, Church J (2009) Polishing the crystal ball: knowing genotype improves ability to predict desmoid disease in patients with familial adenomatous polyposis. Dis Colon Rectum 52:1762-1766. https://doi.org/10.1007/DCR.0b013e3181b5518a

    Article  PubMed  Google Scholar 

  35. Parc Y, Piquard A, Dozois RR, Parc R, Tiret E (2004) Long-term outcome of familial adenomatous polyposis patients after restorative coloproctectomy. Ann Surg 239:378-382. https://doi.org/10.1097/01.sla.0000114216.90947.f6

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ueno H, Kobayashi H, Konishi T, Ishida F, Yamaguchi T, Hinoi T, Kanemitsu Y, Inoue Y, Tomita N, Matsubara N, Komori K, Ozawa H, Nagasaka T, Hasegawa H, Koyama M, Akagi Y, Yatsuoka T, Kumamoto K, Kurachi K, Tanakaya K, Yoshimatsu K, Watanabe T, Sugihara K, Ishida H (2016) Prevalence of laparoscopic surgical treatment and its clinical outcomes in patients with familial adenomatous polyposis in Japan. Int J Clin Oncol 21:713-722. https://doi.org/10.1007/s10147-016-0953-5

    Article  CAS  PubMed  Google Scholar 

  37. Saito Y, Hinoi T, Ueno H, Kobayashi H, Konishi T, Ishida F, Yamaguchi T, Inoue Y, Kanemitsu Y, Tomita N, Matsubara N, Komori K, Kotake K, Nagasaka T, Hasegawa H, Koyama M, Ohdan H, Watanabe T, Sugihara K, Ishida H (2016) Risk factors for the development of desmoid tumor after colectomy in patients with familial adenomatous polyposis: multicenter retrospective cohort study in Japan. Ann Surg Oncol 23:559-565. https://doi.org/10.1245/s10434-016-5380-3

    Article  PubMed  Google Scholar 

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Funding

This study is supported by the National Natural Science Foundation of China (#81570596 and 81770557).

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Authors and Affiliations

  1. Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, 510655, Guangdong, China

    Minghao Xie, Yongle Chen, Xiaowen He, Xianzhe Li, Lei Lian & Ping Lan

  2. Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

    Minghao Xie, Xianzhe Li, Lei Lian & Ping Lan

  3. Department of General Surgery, The People’s Hospital of Gaozhou, Gaozhou, Guangdong, China

    Wancheng Wei

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  1. Minghao Xie
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Minghao Xie and Yongle Chen contributed equally to this paper.

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Xie, M., Chen, Y., Wei, W. et al. Does ileoanal pouch surgery increase the risk of desmoid in patients with familial adenomatous polyposis?. Int J Colorectal Dis 35, 1599–1605 (2020). https://doi.org/10.1007/s00384-020-03578-y

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