Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients
- aThe Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, the Netherlands, bDepartment of Gastroenterology, Leiden University Medical Centre, the Netherlands, cDepartment of Surgery, Academic Medical Centre, Amsterdam, the Netherlands, dDepartment of Clinical Epidemiology, University Hospital Utrecht, the Netherlands, eThe Danish Polyposis Registry, Hvidovre Hospital, Copenhagen, Denmark, fThe Swedish Polyposis Registry, Department of Gastroenterology and Hepatology, Karolinska Hospital, Stockholm, Sweden, gDepartment of Surgery, University of Helsinki, Finland
- Dr H F A Vasen, The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden University Medical Centre (Poortgebouw), Rijnsburgerweg 10, 2333 AA Leiden, the Netherlands. nfdht{at}xs4all.nl
- Accepted 17 January 2001
Abstract
BACKGROUND AND AIMS The choice of colorectal surgery in patients with familial adenomatous polyposis lies between the morbidity of proctocolectomy and ileum-pouch-anal anastomosis (IPAA) and the mortality from rectal cancer after total colectomy and ileorectal anastomosis (IRA). The aims of the present study were: (1) to assess the risk of dying from rectal cancer after IRA, (2) to compare the life expectancy between patients with an IRA and those with an IPAA, and (3) to investigate whether regular endoscopic examination of the rectum leads to detection of cancer at an earlier stage.
METHODS Clinical and pathological data on 659 patients who underwent colectomy and ileorectal anastomosis were collected from four national polyposis registries—that is, in Denmark, Finland, Sweden, and the Netherlands. Data were analysed using survival analysis methods. Decision analysis was used to compare the life expectancy between patients with an IRA and those with an IPAA.
RESULTS A total of 47 patients developed rectal cancer after IRA. The risk of dying from rectal cancer was 12.5% (95% confidence interval 7.1–17.9%) by age 65. Compared with IRA, IPAA would lead to an increase in life expectancy of 1.8 years. Seventy five per cent of patients with rectal cancer had a negative rectoscopy within 12 months before the diagnosis.
CONCLUSION IRA is associated with substantial mortality due to rectal cancer. Follow up examinations of the rectum does not have sufficient preventive effect on morbidity and mortality of rectal cancer.
Footnotes
- Abbreviations used in this paper:
- IPAA
- ileum-pouch-anal anastomosis
- IRA
- ileorectal anastomosis
- FAP
- familial adenomatous polyposis
- NSAIDs
- non-steroidal anti-inflammatory drugs
