The Desmoid Tumor Research Foundation

July 2024

Development of desmoid tumours after ileorectal anastomosis versus ileal pouch-anal anastomosis in familial adenomatous polyposis

Author Information

Arthur S Aelvoet 1, Maria Pellisé 2, Thymen N Miedema 1, Maria Daca-Alvarez 2, Barbara A J Bastiaansen 1, Monique E van Leerdam 3, Rodrigo Jover 4, Francesc Balaguer 2, Michal F Kaminski 5, Francesco Buttitta 6, Luigi Ricciardiello 6, Niels Jespersen 7, John G Karstensen 8, Patrick M Bossuyt 9, Andrew Latchford 10, Roel Hompes 11, Evelien Dekker 12; European FAP Consortium

1Amsterdam UMC location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands. 2Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain. 3Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands. 4Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain. 5Department of Oncological Gastroenterology and Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 6Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy. 7Danish Polyposis Registry. Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark. 8Danish Polyposis Registry. Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 9Amsterdam UMC location University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands. 10Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom; Department of Surgery and Cancer, Imperial College, London, United Kingdom. 11Cancer Centre Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands. 12Amsterdam UMC location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Cancer Centre Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands. Electronic address: e.dekker@amsterdamumc.nl.

Publication

Clin Gastroenterol Hepatol

Summary

Background & aims: Desmoid tumours (DT) are an important cause of morbidity and mortality in patients with familial adenomatous polyposis (FAP). DT development might be related to the type and approach of colectomy. We aimed to compare DT development after colectomy with ileorectal anastomosis (IRA) and proctocolectomy with ileal pouch-anal anastomosis (IPAA). Methods: We performed an international historical cohort study in FAP patients who underwent IRA or IPAA between 1961 and 2020. The primary outcome was the incidence of abdominal DT (either mesenteric, retroperitoneal or abdominal wall). Patients with a DT diagnosis before or at colectomy were excluded. Time to DT was considered censored at an eventual secondary proctectomy after IRA. We used multivariable Cox regression modelling to adjust for potential confounders. Results: We analysed data from 852 patients: 514 after IRA and 338 after IPAA (median follow-up 21 and 16 years, respectively). DTs were diagnosed in 64 IRA patients (12%) and 66 IPAA patients (20%). The cumulative DT incidence at 5 and 10 years was 7.5% and 9.3% after open IRA and 4.7% and 10.9% after laparoscopic IRA. These estimates were 13.6% and 15.4% after open IPAA and 8.4% and 10.0% after laparoscopic IPAA. The post-operative risk was significantly higher after IPAA (p < 0.01) in multivariable analysis, while approach did not significantly influence the risk. Conclusions: The risk of developing an abdominal DT was found to be significantly higher after IPAA than after IRA. Postoperative DT risk should be taken into account when choosing between IRA and IPAA in FAP.

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