Surgical treatment of familial adenomatous polyposis: Dilemmas and current recommendations

Table 4 Recommendations for surgical treatment based on clinical and genetic features

Operation	IRA	RPC
Indications	Mild FAP or MAP (< 20 rectal or < 1000 colonic polyps)AFAP by family history, endoscopy or genetic testingNo colorectal carcinomaYoung women without definitive offspringMetastatic CRC	Many (> 20) rectal adenomas or > 3 cm or high-grade dysplasiaSevere colonic phenotype(> 1000) or family historyColorectal carcinomaMutations in codon 1309Mesenteric desmoid or family history or APC mutation (codons 1403-1578)
Pros	Technically simple, good function, low morbidity, no pelvic dissection
Cons	Metachronous rectal cancer	Technically demandingHigh morbidity

AFAP: Attenuated familial adenomatous polyposis; MAP: MYH associated polyposis; IRA: Ileorectal anastomosis; CRC: Colorectal cancer; RPC: Restorative proctocolectomy; APC: Adenomatous polyposis coli.