Current status of prophylactic surgical treatment for familial adenomatous polyposis in Japan
Masato Yamadera1, Hideki Ueno2, Hirotoshi Kobayashi3
1Department of Surgery, National Defense Medical College, Saitama, Japan.
Insights
Prophylactic colectomy for familial adenomatous polyposis (FAP) in Japan shows good short-term outcomes. Current practices involve limited indications for attenuated FAP, delayed colectomy, and increased laparoscopic surgery use.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Genetics
Background:
- Familial adenomatous polyposis (FAP) is a hereditary condition predisposing individuals to colorectal cancer.
- Prophylactic colectomy is a standard management strategy for FAP patients to prevent cancer development.
- Understanding current surgical practices is crucial for optimizing patient outcomes.
Purpose of the Study:
- To clarify the contemporary clinical practice of prophylactic colectomy for FAP in Japan.
- To evaluate trends in surgical indications, timing, and techniques over time.
Main Methods:
- A retrospective multi-center cohort study involving 147 FAP patients who underwent prophylactic colectomy between 2000 and 2012.
- Data were collected from 23 specialized colorectal disease institutions in Japan.
- Patients were categorized into two groups based on surgery date: Group 1 (2000-2006) and Group 2 (2007-2012).
Main Results:
- The mean age at prophylactic surgery increased from 27 to 31 years between Group 1 and Group 2.
- The proportion of attenuated FAP cases decreased significantly in Group 2 (1.0%) compared to Group 1 (13%).
- Malignant polyps were more frequent in Group 2 resections (23%) versus Group 1 (10%), with a P-value of 0.034. Laparoscopic surgery increased from 40% in Group 1 to 61% in Group 2.
Conclusions:
- Prophylactic colectomy for FAP in Japan yields favorable short-term surgical outcomes.
- Current practices indicate a trend towards more selective surgical indications for attenuated FAP.
- There is a discernible shift towards delayed colectomy and increased adoption of laparoscopic surgical approaches.
Purpose:
We conducted this study to clarify the current clinical practice of prophylactic colectomy for patients with familial adenomatous polyposis (FAP) in Japan.
Methods:
This retrospective multi-center cohort study involved 23 specialized institutions for colorectal disease in Japan. We analyzed the records of 147 patients who underwent prophylactic surgical treatment between 2000 and 2012. Patients were divided into Group 1 (2000-2006) and Group 2 (2007-2012) based on their date of surgery.
Results:
Age at the time of prophylactic surgery was 27 and 31 years in Groups 1 and 2, respectively. The proportion of attenuated FAP was significantly lower in Group 2 than in Group 1 (1.0 vs. 13 %, respectively). Pathological examination revealed an increased incidence of malignant polyps in the resected specimens from Group 2 patients (10 vs. 23 %, respectively; P = 0.034). Laparoscopic surgery was more frequent in Group 2 than in Group 1 (61 vs. 40 %, respectively). There was no surgical mortality in either group.
Conclusion:
Prophylactic surgery for FAP results in good short-term surgical outcomes in Japan. The current surgical approach is characterized by limited surgical indications for patients with attenuated FAP, delayed timing of colectomy, and the increasing standardization of laparoscopic surgery.
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