Surgical Treatment and Postoperative Surveillance for Familial Adenomatous Polyposis

Familial adenomatous polyposis (FAP) is a genetic disease caused by APC mutation. It develops into multiple adenomatous polyps when patients are in their early 20s and eventually transforms into colorectal cancer at 100% penetrance unless treated. Therefore, prophylactic surgery is the only effective treatment option. However, individual approaches such as total colectomy with ileorectal anastomosis, proctocolectomy with stapled ileal pouch-anal anastomosis (IPAA), proctocolectomy with mucosectomy, hand-sewn IPAA, and total proctocolectomy with end ileostomy are required based on the balance between the risk of metachronous rectal cancer, postoperative complications, and decreased anal function. Herein, we summarize the current evidence regarding the surgical treatment and postoperative surveillance for FAP.