The Desmoid Tumor Research Foundation

August 2026

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

Author Information

Phuong Minh Tang 1, Bui Thien Nghiep Vo 2, Tung-Cheng Chang 3, El-Wui Loh 4, Ka-Wai Tam 5

1International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of General Surgery, Tra Vinh General Hospital, Tra Vinh, Vietnam. 2International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 3Division of Colorectal Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Division of Colorectal Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 4Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. 5Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: kelvintam@tmu.edu.tw.

Publication

J Gastrointest Surg

Summary

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.

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