A patient after a proctocolectomy is cleared from col-orectal cancer, but he is not entirely free from troubles. Duodenal adenomas might be the next problem, moreover desmoids are also a recognised entity in FAP. The lifetime risk of developing duodenal cancer in familial adenomatous polyposis (FAP) is about 5%. When and to what extent surgical intervention should be undertaken to prevent death from invasive carcinoma is controversial . Of 48 proctocolectomies with a mean follow-up of 74 months (range, 3-288 months), Tulchinsky et al.  reported the development of extra-colonic manifestations including desmoid tumours (in 12), duodenal adenomas (in 9), pouch adenomas (in 5), and rectal stump adenomas (in 3), in 38 patients. Two patients died (4%) because of desmoid tumour and malignant fibrous histiocytoma.
Aiming to prevent duodenal polyps, enteral ade-nomatous polyposis coli gene replacement therapy in mice has awakened interest . Preclinical studies of gene transfer for the treatment of desmoid disease in familial adenomatous polyposis  is under study and seems an attractive alternative for the treatment of desmoids, but it is too early to understand if this will develop into a clinical application.
Conservative surgical treatments such as pancreas-preserving total duodenectomy in familial ade-nomatous polyposis have been advocated, but surgery cannot be considered a future trend for a genetic disease.
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