Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis
김혜진, 최규석, 박준석, 박수연, Choi Wohn-Ho, Ryuk Jong-Pil,
소속 상세정보
김혜진 ( Kim Hye-Jin )
Kyungpook National University School of Medicine Colorectal Cancer Center
최규석 ( Choi Gyu-Seog )
Kyungpook National University School of Medicine Colorectal Cancer Center
박준석 ( Park Jun-Seok )
Kyungpook National University School of Medicine Colorectal Cancer Center
박수연 ( Park Soo-Yeun )
Kyungpook National University School of Medicine Colorectal Cancer Center
( Choi Wohn-Ho )
Kyungpook National University School of Medicine Colorectal Cancer Center
( Ryuk Jong-Pil )
Kyungpook National University School of Medicine Colorectal Cancer Center
KMID : 0371320120830050288
Abstract
Purpose: We evaluated the short- and long-term outcomes of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC/IPAA) for treatment of familial adenomatous polyposis (FAP). Also, we assessed the oncologic outcomes in FAP patients with coexisting malignancy.
Methods: From August 1999 to September 2010, 43 FAP patients with or without coexisting malignancy underwent TPC/IPAA by a laparoscopic-assisted or hand-assisted laparoscopic surgery.
Results: The median age was 33 years (range, 18 to 58 years) at the time of operation. IPAA was performed by a hand-sewn method in 21 patients (48.8%). The median operative time was 300 minutes (range, 135 to 610 minutes), which reached a plateau after 22 operations. Early postoperative complications within 30 days occurred in 7 patients (16.3%) and long-term morbidity occurred in 15 patients (34.9%) including 6 (14.0%) with desmoid tumors and 3 (7.0%) who required operative treatment. Twenty-two patients (51.2%) were diagnosed with coexisting colorectal malignancy. The median follow-up was 58.5 months (range, 7.9 to 97.8 months). There was only 1 case of local recurrence in the pelvic cavity. No cases of adenocarcinoma at the residual rectal mucosa developed. 5-year disease-free survival rate for 22 patients who had coexisting malignancy was 86.5% and 5-year overall survival rate was 92.6%. Three patients died from pulmonary or hepatic metastasis.
Conclusion: Laparoscopic TPC/IPAA in patients with FAP is feasible and offers favorable postoperative outcomes. It also delivered acceptable oncological outcomes in patients with coexisting malignancy. Therefore, laparoscopic TPC/IPAA may be a favorable treatment option for FAP.
키워드
Laparoscopic total proctocolectomy; Ileal pouch-anal anastomosis; Familial adenomatous polyposis
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