Genotype and phenotype factors as determinants for rectal stump cancer in patients with familial adenomatous polyposis

Lucio Bertario, Antonio Russo, Paolo Radice, Liliana Varesco, Marco Eboli, Pasquale Spinelli, Arturo Reyna, Paola Sala

Research output: Contribution to journalArticle

Abstract

Objective: To identify factors influencing the occurrence of cancer in the rectal remnant in patients with familial adenomatous polyposis (FAP) after colectomy and ileoreotal anastomosis (IRA). Summary Background Data: The risk for rectal cancer in patients with FAP after colectomy and IRA remains a major concern. Methods: Between 1955 and 1997, 371 patients (206 men, 165 women) from the Registry of Hereditary Colorectal Tumors underwent colectomy and IRA as a primary surgical procedure. Survival was estimated using the Kaplan-Meier method. Cox proportional hazard models were fitted to assess the relative excess risk of rectal cancer and to control for confounding factors. A multivariate analysis was performed to assess the relation between cancer risk in the rectum and sex, age, number of rectal polyps, colon cancer, and APC germline mutation. Results: Median follow-up was 81 months. Eighty-nine patients (24%) had colon cancer at the time of surgery. The APC mutation was found in 200 patients. In 27 patients, cancer developed in the retained rectum 1 to 26 years after surgery. The incidence of rectal carcinoma appears to increase with time: at 10, 15, and 20 years after surgery, the cumulative risk was 7.7%, 13.1%, and 23.0%, respectively. Multivariate analysis identified as independent predictors the presence of colon cancer at IRA and a mutation occurring between codons 1250 and 1464; both factors increased the risk nine times. Conclusions: The presence of cancer at IRA and APC mutation type are the most important risk factors for the future development of cancer in the rectal remnant in patients with FAP.

Original languageEnglish
Pages (from-to)538-543
Number of pages6
JournalAnnals of Surgery
Volume231
Issue number4
DOIs
Publication statusPublished - Apr 2000

ASJC Scopus subject areas

  • Surgery

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