The major concern with colectomy and IRA as a prophylactic surgical option in patients with FAP is the subsequent risk of rectal cancer. It was easier to recommend IRA to patients, and many surgeons prefer this option after the advent of the ileoanal reservoir. The actual documented risk of dying of cancer of the rectum subsequent to colectomy and IRA is somewhat small . The risk of developing polyps and cancer are, of course, higher. It would appear that proctoscopic surveillance and ablation of polyps that arise in the rectal segment are possible, but this does not eliminate fully the risk of rectal cancer. Long-term follow-up studies demonstrate that development of cancer does not always equate with death from that cancer. IRA is compatible with good functional results. It is a simpler procedure than the ileoanal reservoir and is usually a one-stage procedure as opposed to the two-stage procedure commonly used to construct an ileoanal reservoir. More recent improvements in surgical technique and skill suggest that a one-stage ileoanal reservoir without temporary ileostomy would be an appropriate option. Refinements in technique achieved in recent years have improved functional results and decreased surgical complications of proctocolectomy and ileoanal reservoir. The ability to perform the operation as a one-stage procedure makes it an appropriated option as a contemporary alternative to IRA. To support use of IRA, there are quality-of-life (QOL) studies . The authors argue that there were no differences with respect to health status between patients in groups of IRA and IAA and that preference for either procedure cannot be based on QOL.
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