Timing of Prophylactic Colectomies among Familial Adenomatous Polyposis Call-up Patients

Laura Koskenvuo1, Heidi Ryynänen2, Anna Lepistö1

1Department of Gastroenterological surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 2Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland

Abstract

Objectives. Optimal timing of prophylactic colectomy in familial adenomatous polyposis (FAP) remains under debate. Our aim was to analyse the timing of prophylactic colectomies by evaluating colorectal cancer prevalence at the time of operation in FAP patients in Finland.

Methods. Of the 452 FAP patients there were 180 call up patients who underwent prophylactic colectomy.  The patient and mutation characteristics as well as surgical technique were collected. The timing of prophylactic colectomy after the FAP diagnosis was analysed as well as time from decision to surgery.

Results. There were 94 colectomies with ileorectal anastomosis, 79 proctocolectomies with ileal pouch-anal anastomosis and seven proctocolectomies with ileostomy. The median age at the diagnosis was 20.9 years and the median age at the time of surgery was 25.2 years. Median time from the operation plan to surgery was four months. There were eight (4%) cancers in the colectomy specimens of which six were found in the first-round endoscopy and two were found among the patients who had refused surveillance. A total of 38 (21%) of the patients died during the follow-up. Twenty-three (61%) of the deaths were of FAP related reasons, of which only six were due to colorectal cancer. The relative survival in 30 years from diagnosis was 84% in men and 78% in women.

Conclusions. Timing of prophylactic surgery was successful as there were no unexpected colorectal cancers found in colectomy specimens among the screened patients. The FAP related extra-colonic manifestations reduce the relative survival of the FAP patients after prophylactic surgery.

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