Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4152
Peer-review started: March 3, 2022
First decision: April 11, 2022
Revised: April 24, 2022
Accepted: July 18, 2022
Article in press: July 18, 2022
Published online: August 14, 2022
Restorative total proctocolectomy is now being implemented as a standard treatment to eliminate the risk of colorectal cancer in patients with familial adenomatous polyposis (FAP). However, the postoperative development of adenomas in the ileal pouch in these individuals has raised new concerns about appropriate postoperative surveillance and management approaches.
More information is needed regarding the incidence, natural course, and risk factors associated with pouch adenoma.
To investigate the cumulative incidence and time to development of pouch adenomas and analyze the clinical factors associated with pouch adenoma development among patients with FAP after restorative proctocolectomy.
A retrospective cohort study was carried out with 95 consecutive patients with FAP who underwent restorative proctocolectomy at Asan Medical Center (Seoul, South Korea) from November 1989 to December 2018.
The cumulative risks of pouch adenoma development at 5, 10, and 15 years after pouch surgery were 15.2%, 29.6%, and 44.1%, respectively. Severe colorectal polyposis (with more than 1000 polyps) was a significant risk factor for pouch adenoma development (hazard ratio, 2.49; 95% confidence interval: 1.04-5.96; P = 0.041).
We recommend endoscopic resection when the adenoma is detected. If numerous polyps are present, random biopsy sampling is required, and polyps larger than 5 mm should be removed. Close surveillance of the pouch should be mandatory, and new guidelines for the management of pouch adenomas are required.
In the future, validation of whether an annual endoscopic interval is appropriate is required, as is an evaluation of the feasibility and effectiveness of endoscopic resection of a pouch adenoma.