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Surg Today. 2017 Jun;47(6):690-696. doi: 10.1007/s00595-016-1431-4. Epub 2016 Oct 21.

Current status of prophylactic surgical treatment for familial adenomatous polyposis in Japan.

Author information

1
Department of Surgery, National Defense Medical College, Saitama, Japan.
2
Department of Surgery, National Defense Medical College, Saitama, Japan. ueno_surg1@ndmc.ac.jp.
3
Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
4
Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
5
Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
6
Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
7
Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
8
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.
9
Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
10
Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
11
Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
12
Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.

Abstract

PURPOSE:

We conducted this study to clarify the current clinical practice of prophylactic colectomy for patients with familial adenomatous polyposis (FAP) in Japan.

METHODS:

This retrospective multi-center cohort study involved 23 specialized institutions for colorectal disease in Japan. We analyzed the records of 147 patients who underwent prophylactic surgical treatment between 2000 and 2012. Patients were divided into Group 1 (2000-2006) and Group 2 (2007-2012) based on their date of surgery.

RESULTS:

Age at the time of prophylactic surgery was 27 and 31 years in Groups 1 and 2, respectively. The proportion of attenuated FAP was significantly lower in Group 2 than in Group 1 (1.0 vs. 13 %, respectively). Pathological examination revealed an increased incidence of malignant polyps in the resected specimens from Group 2 patients (10 vs. 23 %, respectively; P = 0.034). Laparoscopic surgery was more frequent in Group 2 than in Group 1 (61 vs. 40 %, respectively). There was no surgical mortality in either group.

CONCLUSION:

Prophylactic surgery for FAP results in good short-term surgical outcomes in Japan. The current surgical approach is characterized by limited surgical indications for patients with attenuated FAP, delayed timing of colectomy, and the increasing standardization of laparoscopic surgery.

KEYWORDS:

Familial adenomatous polyposis; Hereditary colorectal cancer; Proctocolectomy; Prophylactic surgery; Total colectomy

PMID:
27770209
DOI:
10.1007/s00595-016-1431-4
[Indexed for MEDLINE]

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