Hideki Ueno1, Hirotoshi Kobayashi2, Tsuyoshi Konishi3, Fumio Ishida4, Tatsuro Yamaguchi5, Takao Hinoi6, Yukihide Kanemitsu7, Yasuhiro Inoue8, Naohiro Tomita9, Nagahide Matsubara9, Koji Komori10, Heita Ozawa11, Takeshi Nagasaka12, Hirotoshi Hasegawa13, Motoi Koyama14, Yoshito Akagi15, Toshimasa Yatsuoka16, Kensuke Kumamoto17, Kiyotaka Kurachi18, Kohji Tanakaya19, Kazuhiko Yoshimatsu20, Toshiaki Watanabe21, Kenichi Sugihara22, Hideyuki Ishida23. 1. Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan. ueno@ndmc.ac.jp. 2. Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo, Japan. 3. Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 4. Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan. 5. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 6. Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 7. Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan. 8. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan. 9. Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan. 10. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 11. Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan. 12. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 13. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 14. Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. 15. Department of Surgery, Kurume University School of Medicine, Kurume, Japan. 16. Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan. 17. Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan. 18. Department of Surgery 2, Hamamatsu University School of Medicine, Hamamatsu, Japan. 19. Department of Surgery, Iwakuni Clinical Center, Iwakuni, Japan. 20. Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. 21. Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 22. Tokyo Medical and Dental University, Tokyo, Japan. 23. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Abstract
BACKGROUND: Laparoscopic surgery is becoming the preferred technique for most colorectal interventions. This study aimed to clarify the time trend of surgical treatment for familial adenomatous polyposis (FAP) and its relevance to clinical outcomes in Japan over a 13-year period. METHODS: This was a multicenter retrospective cohort study comprising 23 specialist institutions for colorectal disease and a cohort of 282 FAP patients who underwent total colectomy or proctocolectomy during 2000-2012. Patient clinical backgrounds and surgical outcomes were compared between the first and second halves of the study period. RESULTS: The proportion of surgical types adopted over the entire study period was 46, 21, 30, and 3 % for ileoanal anastomosis (IAA), ileoanal canal anastomosis, ileorectal anastomosis, and permanent ileostomy, respectively. FAP patients undergoing laparoscopic surgery have increased since 2008 and reached 74 % in the past 3 years. In particular, the number of patients undergoing laparoscopic proctocolectomy with IAA increased approximately four-fold from the first to the second half of the study period. A laparoscopic approach was increasingly used in patients with coexisting colorectal malignancies. Despite this trend, surgical results of the laparoscopic approach between the two study periods showed similar morbidity, pouch operation and stoma closure completion rates. No postoperative mortality was observed in this series, and laparoscopic surgery was comparable to open surgery in terms of stoma closure rate, incidence of intra-abdominal/abdominal desmoid tumors, and postoperative survival rate in both study periods. CONCLUSION: Laparoscopic approach is increasingly being adopted for prophylactic FAP surgery in Japan and may provide clinically acceptable practical outcomes.
BACKGROUND: Laparoscopic surgery is becoming the preferred technique for most colorectal interventions. This study aimed to clarify the time trend of surgical treatment for familial adenomatous polyposis (FAP) and its relevance to clinical outcomes in Japan over a 13-year period. METHODS: This was a multicenter retrospective cohort study comprising 23 specialist institutions for colorectal disease and a cohort of 282 FAPpatients who underwent total colectomy or proctocolectomy during 2000-2012. Patient clinical backgrounds and surgical outcomes were compared between the first and second halves of the study period. RESULTS: The proportion of surgical types adopted over the entire study period was 46, 21, 30, and 3 % for ileoanal anastomosis (IAA), ileoanal canal anastomosis, ileorectal anastomosis, and permanent ileostomy, respectively. FAPpatients undergoing laparoscopic surgery have increased since 2008 and reached 74 % in the past 3 years. In particular, the number of patients undergoing laparoscopic proctocolectomy with IAA increased approximately four-fold from the first to the second half of the study period. A laparoscopic approach was increasingly used in patients with coexisting colorectal malignancies. Despite this trend, surgical results of the laparoscopic approach between the two study periods showed similar morbidity, pouch operation and stoma closure completion rates. No postoperative mortality was observed in this series, and laparoscopic surgery was comparable to open surgery in terms of stoma closure rate, incidence of intra-abdominal/abdominal desmoid tumors, and postoperative survival rate in both study periods. CONCLUSION: Laparoscopic approach is increasingly being adopted for prophylactic FAP surgery in Japan and may provide clinically acceptable practical outcomes.
Entities:
Keywords:
Desmoid tumor; Familial adenomatous polyposis (FAP); Laparoscopic surgery; Total colectomy; Total proctocolectomy
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