ILEAL POUCH-ANAL ANASTOMOSIS WITH MESORECTAL EXCISION FOR RECTAL-CANCER COMPLICATING FAMILIAL ADENOMATOUS POLYPOSIS

Objective: To assess the long term results of ileal pouch-anal anastom osis (IPAA) with mesorectal excision for rectal carcinoma complicating familial adenomatous polyposis (FAP). Design: Retrospective study. Se tting: Teaching hospital, France. Subjects: 6 patients with FAP and as sociated rectal carcinoma and 87 patients who underwent IPAA for benig n disease. Main outcomes measures: Morbidity and mortality. Results: T here were no postoperative deaths and no significant differences betwe en the groups in postoperative morbidity. Mean follow-up was 35 months . Two patients in the cancer group died 33 and 40 months after IPAA of liver metastases, but had no evidence of local recurrence. There were no recurrences among the other 4 patients. There were no significant differences between the groups in stool frequency, continence, gas/sto ol discrimination, leak, or need for protective pads. The risk of impo tence and retrograde ejaculation was higher (but not significantly) in men with rectal cancer than in those with benign disease (1/4, 25% co mpared with 1/47, 2%; p = 0,15). Conclusion: In cases of rectal carcin oma complicating FAP, IPAA with mesorectal excision should be proposed as an alternative to coloproctectomy with definitive ileostomy. Long term functional evaluation showed that continence and defaecation were similar to those followed up after IPAA for benign disease.