Current guidelines in the surgical management of hereditary colorectal cancers

Table 1 Comparing the three main surgical options in familial adenomatosis polyposis[6,30,39-41]

Surgical procedure	Indications	Benefits	Pitfalls
Ileo-rectal anastomosis	< 20 rectal, adenomas; < 1000 colonic, adenomas	Controls colonic polyposis. Better bowel function & good quality of life. Reduced risk of desmoid disease. Avoids stoma. Quicker recovery, especially useful in active teenagers	Risk of rectal cancer. Annual surveillance with proctoscopy & flexible sigmoidoscopy is required
Ileal pouch-anal anastomosis	< 20 rectal, adenomas; < 1000 colonic, adenomas	Removes nearly all polyps in colon & rectum. No need of permanent ileostomy. Quality of life is satisfactory	Increased complications. Unpredictable bowel function. Unpredictable quality of life. Possible need for ileostomy. Pouch complications: (1) Risk of pouch polyposis; and (2) Risk of cancer in anal transition zone. Surveillance is difficult
Proctocolectomy & end ileostomy	Low rectal cancer. When Ileal pouch-anal anastomosis is not indicated. Poor anal sphincter. Function	Complete removal of cancer risk in lower gastrointestinal tract	Permanent ileostomy. Sexual and fertility consequences such as dyspareunia, decrease in fertility, vaginal discharge in females and reduced libido, sexual satisfaction in males