Familyal Adenomatöz Polipozis Koli’li hastalarda Klinik ve Cerrahi Tedavi Sonuçlarımız

Year 2021, Volume: 5 Issue: 3, 184 - 190, 22.12.2021

Ramazan Gündoğdu , Hakan Yabanoğlu , Serkan Erkan , Murat Kuş

https://doi.org/10.46332/aemj.790063

Abstract

Amaç: Familyal adenomatöz polipozis koli (FAP) kolorektal bölgede çok sayıda adenomatöz polip ile karakterizedir. FAP hastalarında kolorektal kanser riski kaçınılmaz olduğundan cerrahi tedavi en belirleyici unsurdur. Bu çalışmada FAP tanısı ile cerrahi tedavi uygulanan hastaların sonuçlarının ve kliniğimizin deneyimlerinin literatüre sunulması amaçlanmıştır.

Araçlar ve Yöntem: Merkezimizde 2011-2020 tarihleri arasında FAP nedeniyle cerrahi uygulanan hastaların dosyaları geriye dönük olarak incelendi. Çoklu veri eksikliği olan hastalar çalışma dışı bırakıldı. 30 hasta çalışmaya alındı. Hastaların bulguları kaydedildi.

Bulgular: Hastaların 13’ü (%43) erkek, 17’si (%57) kadındı. Hastaların 17’sine (%57) total proktokolektomi (TPK), 13’üne (%43) TK yapıldı. Hastaların kolonoskopilerinin 15’i malignite şüphesi içeriyordu. Bu hastaların kolonoskopik biyopsilerin 8’i adenokanserdi. Hastaların 20’sinde (%67) spesmen patolojisi adenokanserdi. Hastaların 10’unda (%33) komplikasyon ve 1’inde mortalite görüldü. Komplikasyonlar TPK (%60) yapılan hastalarda daha çoktu.

Sonuç: FAP daha çok kolonu ilgilendirse de üst gastrointestinal sistemi de tutabilmektedir. Cerrahi, halen tedavinin en önemli basamağını oluştursa da komplikasyon oranları azımsanmayacak düzeylerdedir. Yapılacak cerrahinin türüne hastanın yaşı, polip yaygınlığı ve takiplere olan uyum durumuna göre karar verilmelidir.

Keywords

Familyal Adenomatöz Polipozis, kanser, kolektomi

Supporting Institution

yok

Our Clinical and Surgical Treatment Results in Familial Adenomatous Polyposis Coli Patients

Abstract

Purpose: Familial adenomatous polyposis coli (FAP) is characterized by multiple adenomatous polyps in the colorectal region. Surgical treatment is the most decisive factor in FAP patients, as the risk of colorectal cancer is inevitable. In this study, it was aimed to present the results of patients who underwent surgical treatment with the diagnosis of FAP and the experiences of our clinic to the
literature.

Materials and Methods: The files of patients who underwent surgery for FAP between 2011 and 2020 in our center were retrospectively reviewed. Patients with multiple data deficiencies were excluded. 30 patients were included in the study. The findings of the patients were recorded.

Results: 13 (43%) of the patients were male, 17 (57%) were female. Total proctocolectomy (TPK) was performed in 17 (57%) of the patients, and TK was performed in 13 (43%) of them. 15 of the patients' colonoscopies included suspicion of malignancy. Eight of the colonoscopic biopsies of these patients were adenocarcinoma. Specimen pathology was adenocarcinoma in 20 (67%) of the patients.
Complications were seen in 10 (33%) of the patients and mortality was seen in 1. Complications were more common in patients with TPK (60%).

Conclusion: Although FAP mostly involves the colon, it may involve the upper gastro intestinal system. Although surgery is still the most important step of the treatment, the complication rates are substantial. The type of surgery to be performed should be decided according to the age of the patient, the prevalence of polyp and compliance with follow-up.

Keywords

Familial Adenomatous Polyposis, Cancer, Colectomy

References

• 1. Bhurwal A, Prochilo G, Patel AV. Familial adenomatous polyposis. Am J Med Sci. 2020;359(6):392-393.
• 2. Nielsen M, Hes FJ, Nagengast FM, et. al. Germline mutations in APC and MUTYH are responsible for the majority of families with attenuated familial adenomatous polyposis. Clin Genet. 2007;71(5):427-433.
• 3. Knudsen AL, Bülow S, Tomlinson I, Möslein G, Heinimann K, Christensen IJ. Attenuated familial denomatous polyposis: resultsfrom an internationa lcollaborative study. Colorectal Dis. 2010;12(10):243–249.
• 4. Half E, Bercovich D, Rozen P. Familial adenomatous polyposis. Orphanet J RareDis. 2009;4(1):22.
• 5. Aliosmanoğlu İ, Gül M, Hakseven M.ve ark. Familyal adenomatöz polipozis nedeniyle ameliyat ettiğimiz 24 hastanın analizi. Kolon Rektum Hast. Derg. 2013;23(1):38-43.
• 6. Arvanitis ML, Jagelman DG, Fazio VW, Lavery IC, McGannon E. Mortality in patients with familial adenomatous polyposis. Dis Colon Rectum. 1990;33(8):639-642.
• 7. Laurent S, Franchimont D, Coppens J. P. et. al. Familial adenomatous polyposis: clinical presentation, detection and surveillance. Acta gastroenterol. 2011;74(3):415-420.
• 8. Aihara H, Kumar N, Thompson CC. Diagnosis, surveillance, and reatment strategies for familial adenomatous polyposis: rationale and update. Eur J Gastroenterol Hepatol. 2014;26(3):255-262.
• 9. Campos FG. Surgical treatment of familial adenomatous polyposis: Dilemmas and currentre commendations. World J Gastroenterol. 2014;20(44):16620-16629.
• 10. Dolan S. Familial adenomatous polyposis: development, presentation, and treatment strategies. Clin J Oncol Nurs. 2019;23(2):135-138.
• 11. Abraham SC, Nobukawa B, Giardiello FM, Hamilton SR, WuTT. Sporadic fundic gland polyps: common gastric polyps arising through activating mutations in the beta-cateningene. Am J Pathol. 2001;158(3):1005-1010.
• 12. Groves CJ, Saunders BP, Spigelman AD, Phillips RK. Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut. 200;50(5):636-641.
• 13. Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RK. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet. 1989;2(8666):783-785.
• 14. Sherman J, Greenstein AJ, Greenstein AJ. Ileal j pouch complications and surgical solutions: a review. Inflamm Bowel Dis. 2014;20(9):1678-1685.
• 15. Aziz O, Athanasiou T, Fazio VW, et al. Meta-analysis of observational studies of ileorectal versus ilealpouch-anal anastomosis for familial adenomatous polyposis. Br J Surg. 2006;93(4):407-417.
• 16. Ng KS, Gonsalves SJ, Sagar PM. Ileal-anal pouches: A review of itshistory, indications, andcomplications. World J Gastroenterol. 2019;25(31):4320-4342.
• 17. Dalal RL, Shen B, Schwartz DA. Management of pouchitis and other common complications of the pouch. Inflamm Bowel Dis. 2018;24(5):989-996.
• 18. Fazio VW, Ziv Y, Church JM, et. al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222(2):120-127.
• 19. Sagar PM, Pemberton JH. Intraoperative, postoperative and reoperative problems with ileoanalpouches. Br J Surg. 2012;99(4):454-468.
• 20. MacLean AR, Cohen Z, MacRae HM, et. al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg. 2002;235(2):200-206.
• 21. Bach SP, Mortensen NJ. Ileal pouch surgery for ulcerativecolitis. World J. Gastroenterol. 2007;13(24):3288-3300.
• 22. Fazio VW, Kiran RP, Remzi FH, et. al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg. 2013;257(4):679-685.
• 23. Schiphorst AH, Verweij NM, Pronk A, Borel Rinkes IH, Hamaker ME. Non-surgical complications after laparoscopic and open surgery for colorectal cancer -A systematic review of randomised controlled trials. Eur J Surg Oncol. 2015;41(9):1118-1127.
• 24. Guzman-Pruneda, F. A., Husain, S. G., Jones, C. D. et.al. Compliance with preoperative care measures reduces surgical site infection after colorectal operation. J. Surg. Oncol. 2019;119(4):497-502.
• 25. Farouk R, Dozois RR, Pemberton JH, Larson D. Incidence and subsequent impact of pelvic abscess after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum. 1998;41(10):1239-1243.
• 26. Pellino G, Frasson M, García-Granero A, et al. ANACO Study Group. Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients. Colorectal Dis. 2018;20(11):986-995.
• 27. Heiskanen I, Luostarinen T, Järvinen HJ. Impact of screening examinations on survival in familial adenomatous polyposis. Scand J Gastroenterol. 2000;35(12):1284-1287.