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World J Gastroenterol. Nov 28, 2014; 20(44): 16620-16629
Published online Nov 28, 2014. doi: 10.3748/wjg.v20.i44.16620
Surgical treatment of familial adenomatous polyposis: Dilemmas and current recommendations
Fábio Guilherme Campos
Fábio Guilherme Campos, Department of Gastroenterology, Colorectal Surgery Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo 01411-001, Brazil
Author contributions: Campos FG contributed to the manuscript.
Correspondence to: Fábio Guilherme Campos, MD, PhD, Department of Gastroenterology, Colorectal Surgery Division, Hospital das Clínicas, University of São Paulo Medical School, Rua Padre João Manoel, 222 Cj 120, São Paulo 01411-001, Brazil.
Telephone: +55-11-30647010 Fax: +55-11-30647010
Received: February 20, 2014
Revised: July 14, 2014
Accepted: August 13, 2014
Published online: November 28, 2014

Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome characterized by multiple adenomatous polyps (predisposing to colorectal cancer development) and numerous extracolonic manifestations. The underlying genetic burden generates variable clinical features that may influence operative management. As a precancerous hereditary condition, the rationale of performing a prophylactic surgery is a mainstay of FAP management. The purpose of the present paper is to bring up many controversial aspects regarding surgical treatment for FAP, and to discuss the results and perspectives of the operative choices and approaches. Preferably, the decision-making process should not be limited to the conventional confrontation of pros and cons of ileorectal anastomosis or restorative proctocolectomy. A wide discussion with the patient may evaluate issues such as age, genotype, family history, sphincter function, the presence or risk of desmoid disease, potential complications of each procedure and chances of postoperative surveillance. Therefore, the definition of the best moment and the choice of appropriate procedure constitute an individual decision that must take into consideration patient’s preferences and full information about the complex nature of the disease. All these facts reinforce the idea that FAP patients should be managed by experienced surgeons working in specialized centers to achieve the best immediate and long-term results.

Keywords: Familial adenomatous polyposis, Surgical treatment, Restorative proctocolectomy, Ileal pouch-anal anastomosis, Ileorectal anastomosis, Adenocarcinomas

Core tip: This paper is an extensive review of the literature focusing the options and criteria for surgical treatment of patients with Familial Adenomatous Polyposis. The author put together a great number of dilemas and the current recommendations in order to help readers to understand how complex the disease is and to summarize the current knowledge.