Comparison of the outcomes of ileal pouch-anal anastomosis and ileorectal anastomosis for patients with familial adenomatous polyposis: A systematic review and meta-analysis

Background: Familial adenomatous polyposis (FAP) is an inherited colorectal cancer syndrome for which ileorectal anastomosis (IRA) preserves the rectum but ileal pouch-anal anastomosis (IPAA) removes it. These procedures may influence the risk of desmoid tumors and involve trade-offs in oncologic protection and bowel function. This study compared the oncologic, desmoid, functional, and postoperative outcomes of IRA and IPAA in FAP.

Methods: PubMed, Embase, Scopus, and the Cochrane Library were searched for relevant studies. Primary outcomes were rectal or pouch-anal cancer and desmoid tumors. Risk of bias was assessed using the ROBINS-I tool, and certainty of evidence was assessed using the GRADE framework. Random-effects meta-analyses were conducted using pooled risk ratios (RRs), mean differences (MDs), and hazard ratios.

Results: Thirty-four studies involving 4,700 patients were included. Compared with IRA, IPAA was associated with lower risks of postoperative rectal and pouch-anal cancer (RR: 0.22, 95% CI: 0.09-0.54) but with a higher risk of desmoid tumors (RR: 1.58, 95% CI: 1.13-2.19). IPAA was associated with higher 24-hour incontinence (RR: 1.90, 95% CI: 1.24-2.92) and 24-hour stool frequency (MD: 1.89 stools/day, 95% CI: 1.29-2.49). Anastomotic stricture was more frequent after IPAA (RR: 2.91, 95% CI: 1.46-5.78), but major complications did not differ substantially between the procedures.

Conclusions: IPAA is associated with greater long-term oncologic protection but worse bowel function and a higher desmoid tumor risk compared with IRA. These findings support individualized procedure selection based on surveillance feasibility to balance functional trade-offs, perioperative risk, and durability.

In patients with familial adenomatous polyposis, intra-abdominal desmoid tumors should be recognized as a rare but important cause of ureteral obstruction and obstructive pyelonephritis. Prompt cross-sectional imaging, early recognition, and multidisciplinary management are essential for preserving renal function, treating infection, and preventing irreversible urinary tract complications.

Breast fibromatosis is a benign, locally aggressive spindle-cell tumor mimicking carcinoma. We report two cases in patients aged 15 and 61 years, highlighting its wide age range. Accurate histopathology prevents overtreatment. Modern management emphasizes individualized care, including active surveillance, complete surgical excision when needed, and long-term follow-up.

While literature surrounding pediatric applications of cryoablation continues to grow and demonstrate potential benefits, evidence to date largely comprises small, retrospective, and uncontrolled series. To address this opportunity, a multidisciplinary panel of pediatric specialists convened virtually in a research consensus panel organized by the Society of Interventional Radiology (SIR); each panelist presented current data surrounding common applications of cryoablation in the pediatric population. A recurring theme throughout the discussion was the potential for cryoablation to increase quality of life in pediatric patients whether applied with curative or palliative intent. After presentations and discussions, research concepts were discussed and ranked on their potential impact, with the following 3 topics emerging as top priorities: (a) thoracic event-free survival and complication comparison between pulmonary metastasectomy and cryoablation of lesions amenable to either modality, (b) a prospective comparison of systemic therapy and cryoablation versus systemic therapy alone in the treatment of desmoid tumor, and (c) the biologic effects of cryoablation on healthy bone, cartilage, and growth plates as may be affected in the treatment of benign osseous lesions.

Purpose of review: To provide a comprehensive review of percutaneous image-guided techniques in the management of desmoid tumors including evolving thermal and non-thermal ablation options, as well as trans-arterial catheter options. Beyond each treatment modality, we aim to highlight considerations related to patient selection, technical components, and the growing interplay between percutaneous therapies and emerging systemic therapies.

Recent findings: Percutaneous ablation, particularly cryoablation, has emerged as a safe and effective treatment for extra-abdominal desmoid tumors, with prospective data demonstrating durable disease control and significant improvements in pain and functional status. A meta-analysis of 694 desmoid tumors treated with thermal ablation reported pooled local control of 88%, symptom relief in 90% of patients, and major complication rates below 5%. Transarterial doxorubicin-eluting embolization has shown promise in both adult and pediatric settings, while bland particle and radioembolic approaches remain under investigation. Irreversible electroporation is emerging as a non-thermal alternative near critical structures. The National Comprehensive Cancer Network (NCCN) Soft Tissue Sarcoma Guidelines now formally incorporate cryoablation along with embolization into the treatment algorithm for progressive, morbid, or symptomatic extra-abdominal desmoid tumors, marking a significant milestone in the recognition of percutaneous techniques as standard-of-care options. Percutaneous image-guided techniques now offer local tumor control with rates similar to surgical resection and a favorable safety profile. Some of these percutaneous techniques are endorsed alongside systemic therapy and radiation as primary options for progressive or symptomatic extra-abdominal desmoid tumors per various guidelines. An important consideration involves the level of data, comprised predominantly of retrospective data, without direct comparative date. The ongoing prospective CRYODESMO-02 trial will help define optimal sequencing and strengthen the evidence base underpinning guideline recommendations.

Introduction: Data about intra-abdominal desmoid-type fibromatosis (IA-DTFs) are limited.

Methods: We examined patients with IA-DTFs enrolled in the ALTITUDES study (NCT02867033). We compared their characteristics with those of other locations using chi-square and Wilcoxon tests, as appropriate, and assessed their outcomes using event-free survival (EFS). Association between primary location and EFS was determined using a Cox univariate model. Subgroup analysis was performed for patients initially managed with active surveillance (AS).

Results: 95/610 tumors (15.5%) enrolled in ALTITUDES were intra-abdominal. Compared with other locations, patients with IA-DTFs were older (p < 0.001), more often men (p < 0.001), had more frequently a history of polyposis (p = 0.001), larger tumors (p = 0.003), different CTNNB1 mutation profiles (p = 0.004), and a diagnosis established more frequently on surgical specimens (p < 0.001). These patients reported less pain (p = 0.01) and fewer emotional difficulties (p = 0.001), but more constipation (p = 0.004). Surgery was the most common first-line approach (51.6%); AS accounted for the management of only 29.5%. Overall, we observed no significant difference between IA-DTFs and other locations in terms of EFS (hazard ratio, HR = 0.84; 95%CI, 0.56-1.26) and overall survival (HR = 1.84; 0.50-6.80). Among patients managed by AS, EFS was similar between both groups (HR = 1.05; 0.55-2.00). Conclusion: One third of IA-DTFs patients were managed using AS, and their outcome was similar to those of patients with other locations. These observational data may help to discuss SA as a first-line approach in the management of IA-DTFs patients.