Ryu HS, Yu CS, Kim YI, Lee JL, Kim CW, Yoon YS, Park IJ, Lim SB, Kim JC. Cumulative incidence and risk factors for pouch adenomas associated with familial adenomatous polyposis following restorative proctocolectomy. World J Gastroenterol 2022; 28(30): 4152-4162 [PMID: 36157110 DOI: 10.3748/wjg.v28.i30.4152]
Corresponding Author of This Article
Chang Sik Yu, MD, PhD, Professor, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. csyu@amc.seoul.kr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Aug 14, 2022; 28(30): 4152-4162 Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4152
Cumulative incidence and risk factors for pouch adenomas associated with familial adenomatous polyposis following restorative proctocolectomy
Hyo Seon Ryu, Chang Sik Yu, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim
Hyo Seon Ryu, Chang Sik Yu, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Author contributions: Ryu HS designed and performed the research and wrote the paper; Yu CS designed the research and supervised the report; Kim YI, Lee JL, Kim CW, Yoon YS, Park IJ, Lim SB, and Kim JC provided clinical advice and supervised the report.
Institutional review board statement: The protocol for this research project has been approved by a suitably constituted ethics committee of the institution (Committee of Asan Medical Center, Approval No. 2021-0309), and it conforms to the provisions of the Declaration of Helsinki.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: This study did not receive a specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang Sik Yu, MD, PhD, Professor, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. csyu@amc.seoul.kr
Received: March 3, 2022 Peer-review started: March 3, 2022 First decision: April 11, 2022 Revised: April 24, 2022 Accepted: July 18, 2022 Article in press: July 18, 2022 Published online: August 14, 2022 Processing time: 159 Days and 19.7 Hours
ARTICLE HIGHLIGHTS
Research background
Restorative total proctocolectomy is now being implemented as a standard treatment to eliminate the risk of colorectal cancer in patients with familial adenomatous polyposis (FAP). However, the postoperative development of adenomas in the ileal pouch in these individuals has raised new concerns about appropriate postoperative surveillance and management approaches.
Research motivation
More information is needed regarding the incidence, natural course, and risk factors associated with pouch adenoma.
Research objectives
To investigate the cumulative incidence and time to development of pouch adenomas and analyze the clinical factors associated with pouch adenoma development among patients with FAP after restorative proctocolectomy.
Research methods
A retrospective cohort study was carried out with 95 consecutive patients with FAP who underwent restorative proctocolectomy at Asan Medical Center (Seoul, South Korea) from November 1989 to December 2018.
Research results
The cumulative risks of pouch adenoma development at 5, 10, and 15 years after pouch surgery were 15.2%, 29.6%, and 44.1%, respectively. Severe colorectal polyposis (with more than 1000 polyps) was a significant risk factor for pouch adenoma development (hazard ratio, 2.49; 95% confidence interval: 1.04-5.96; P = 0.041).
Research conclusions
We recommend endoscopic resection when the adenoma is detected. If numerous polyps are present, random biopsy sampling is required, and polyps larger than 5 mm should be removed. Close surveillance of the pouch should be mandatory, and new guidelines for the management of pouch adenomas are required.
Research perspectives
In the future, validation of whether an annual endoscopic interval is appropriate is required, as is an evaluation of the feasibility and effectiveness of endoscopic resection of a pouch adenoma.
