The Aftermath of Prophylactic Colectomy

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 [16]. Of 48 proctocolectomies with a mean follow-up of 74 months (range, 3-288 months), Tulchinsky et al. [17] 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 [18]. Preclinical studies of gene transfer for the treatment of desmoid disease in familial adenomatous polyposis [19] 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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