Yasufumi Saito1, Takao Hinoi2, Hideki Ueno3, Hirotoshi Kobayashi4, Tsuyoshi Konishi5, Fumio Ishida6, Tatsuro Yamaguchi7, Yasuhiro Inoue8, Yukihide Kanemitsu9, Naohiro Tomita10, Nagahide Matsubara10, Koji Komori11, Kenjiro Kotake12, Takeshi Nagasaka13, Hirotoshi Hasegawa14, Motoi Koyama15, Hideki Ohdan1, Toshiaki Watanabe16, Kenichi Sugihara17, Hideyuki Ishida18. 1. Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. 2. Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. thinoi@hiroshima-u.ac.jp. 3. Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan. 4. Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Bunkyō, Tokyo, Japan. 5. Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 6. Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanazawa, Japan. 7. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 8. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsk, Mie, Japan. 9. Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan. 10. Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. 11. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan. 12. Department of Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan. 13. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 14. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 15. Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan. 16. Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyō, Tokyo, Japan. 17. Tokyo Medical and Dental University, Bunkyō, Tokyo, Japan. 18. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Abstract
BACKGROUND: Desmoid tumor (DT) is the primary cause of death in patients with familial adenomatous polyposis (FAP) after restorative proctocolectomy. This study aimed to identify risk factors for DT in a Japanese population. METHODS: Clinical data for 319 patients with FAP undergoing first colectomy from 2000 to 2012 were reviewed retrospectively. RESULTS: Two hundred seventy-seven FAP patients were included in this study. Thirty-nine (14.1 %) patients developed DT. Occurrence sites were the intraperitoneal region in 25 (64.1 %) cases, intraperitoneal region and abdominal wall in three (7.7 %), and abdominal wall in nine (23.1 %). The mean period from surgery to DT development was 26.3 months (range 4-120 months). Gender (female vs. male, p = 0.03), age at surgery (>30 vs. ≤30 years, p = 0.02), purpose of surgery (prophylactic vs. cancer excision, p = 0.01), and surgical procedure (proctocolectomy [ileoanal anastomosis (IAA), ileoanal canal anastomosis (IACA), total proctocolectomy (TPC)] vs. total colectomy [ileorectal anastomosis, partial colectomy]; p = 0.03) significantly influenced the estimated cumulative risk of developing DT at 5 years after surgery. Conversely, approach (laparoscopic vs. open, p = 0.17) had no significant effect on the increased risk of DT occurrence. In multivariate analysis, female gender, with a hazard ratio of 2.2 (p = 0.02,) and proctocolectomy (IAA, IACA, TPC), with a hazard ratio of 2.2 (p = 0.03), were independent risk factors for DT incidence after colectomy. CONCLUSIONS: Female gender and proctocolectomy (IAA, IACA, TPC) were independent risk factors for developing DT after colectomy in patients with FAP.
BACKGROUND:Desmoid tumor (DT) is the primary cause of death in patients with familial adenomatous polyposis (FAP) after restorative proctocolectomy. This study aimed to identify risk factors for DT in a Japanese population. METHODS: Clinical data for 319 patients with FAP undergoing first colectomy from 2000 to 2012 were reviewed retrospectively. RESULTS: Two hundred seventy-seven FAPpatients were included in this study. Thirty-nine (14.1 %) patients developed DT. Occurrence sites were the intraperitoneal region in 25 (64.1 %) cases, intraperitoneal region and abdominal wall in three (7.7 %), and abdominal wall in nine (23.1 %). The mean period from surgery to DT development was 26.3 months (range 4-120 months). Gender (female vs. male, p = 0.03), age at surgery (>30 vs. ≤30 years, p = 0.02), purpose of surgery (prophylactic vs. cancer excision, p = 0.01), and surgical procedure (proctocolectomy [ileoanal anastomosis (IAA), ileoanal canal anastomosis (IACA), total proctocolectomy (TPC)] vs. total colectomy [ileorectal anastomosis, partial colectomy]; p = 0.03) significantly influenced the estimated cumulative risk of developing DT at 5 years after surgery. Conversely, approach (laparoscopic vs. open, p = 0.17) had no significant effect on the increased risk of DT occurrence. In multivariate analysis, female gender, with a hazard ratio of 2.2 (p = 0.02,) and proctocolectomy (IAA, IACA, TPC), with a hazard ratio of 2.2 (p = 0.03), were independent risk factors for DT incidence after colectomy. CONCLUSIONS: Female gender and proctocolectomy (IAA, IACA, TPC) were independent risk factors for developing DT after colectomy in patients with FAP.
Authors: Timothy Chittleborough; Shienny Sampurno; Sandra Carpinteri; Andrew Craig Lynch; Alexander Graham Heriot; Robert George Ramsay Journal: Pleura Peritoneum Date: 2019-11-02