Cumulative incidence and risk factors for pouch adenomas associated with familial adenomatous polyposis following restorative proctocolectomy  

作　　者：Hyo Seon Ryu Chang Sik Yu Young Il Kim Jong Lyul Lee Chan Wook Kim Yong Sik Yoon In Ja Park Seok-Byung Lim Jin Cheon Kim 

机构地区：[1]Division of Colon and Rectal Surgery,Department of Surgery,University of Ulsan College of Medicine,Asan Medical Center,Seoul 05505,South Korea

出　　处：《World Journal of Gastroenterology》2022年第30期4152-4162,共11页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND The emergence of restorative total proctocolectomy has significantly reduced the lifetime colorectal cancer risk associated with familial adenomatous polyposis(FAP).However,adenomas may develop in the ileal pouch over time and may even progress to carcinoma.We evaluated the cumulative incidence,time to development,and risk factors associated with ileal pouch adenoma.AIM To evaluate the cumulative incidence,time to development,and risk factors associated with pouch adenoma.METHODS In this retrospective,observational study conducted at a tertiary center,95 patients with FAP who underwent restorative proctocolectomy at our center between 1989 and 2018 were consecutively included.The mean follow-up period was 88 mo.RESULTS Pouch adenomas were found in 24(25.3%)patients,with a median time of 52 mo to their first formation.Tubular adenomas were detected in most patients(95.9%).There were no high-grade dysplasia or malignancies.Of the 24 patients with pouch adenomas,13 had all detected adenomas removed.Among the 13 patients who underwent complete adenoma removal,four(38.5%)developed recurrence.Among 11(45.8%)patients with numerous polyps within the pouch,seven(63.6%)exhibited progression of pouch adenoma.The cumulative risks of pouch adenoma development at 5,10,and 15 years after pouch surgery were 15.2%,29.6%,and 44.1%,respectively.Severe colorectal polyposis(with more than 1000 polyps)was a significant risk factor for pouch adenoma development(hazard ratio,2.49;95% confidence interval:1.04-5.96;P=0.041).CONCLUSION Pouch adenomas occur at a fairly high rate in association with FAP after restorative proctocolectomy,and a high colorectal polyp count is associated with pouch adenoma development.

关 键 词：Adenomatous polyposis coli Familial adenomatous polyposis ADENOMA Intestinal polyps Proctocolectomy restorative Ileal pouch anal anastomosis 

分 类 号：R735.34[医药卫生—肿瘤]