QUALITY-OF-LIFE AFTER PROPHYLACTIC COLECTOMY AND ILEORECTAL ANASTOMOSIS IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS

BACKGROUND: Prophylactic colectomy or proctocolectomy is standard trea tment for colorectal manifestation of familial adenomatous polyposis ( FAP), a dominantly inherited disorder for which the risk of developing colorectal cancer in an untreated patient is close to 100 percent. He reditary nonpolyposis colorectal cancer (HNPCC) is also dominantly inh erited but has a lower risk of colorectal cancer than FAP and does not have a clinically obvious phenotype. The role of prophylactic colecto my in patients with HNPCC is controversial. PURPOSE: This study was pe rformed to examine the outcome of colectomy and ileorectal anastomosis (IRA) so its use as a prophylactic procedure can be better evaluated. METHODS: Records of all patients undergoing IRA for FAP between 1985 and 1993 were reviewed. Demographic data and data about the operation were collected. Surgical outcome data included length of hospital stay , complications, bowel function, quality of life, and patient satisfac tion. RESULTS: There were 51 patients with a median age of 28 years; 2 4 were male. All but eight patients were asymptomatic, and all had les s than 1,000 polyps in the resected specimen. Mean surgery time was 3. 5 hours, mean blood loss was 406 ml, and median length of hospital sta ir was seven days. There were no deaths, and eight patients (16 percen t) had complications. Mean number of stools per day after median follo w-up of 4.2 years was 3.6. Only 11 patients had nighttime stooling. Fo ur patients reported seepage, 9 had some incontinence, and 16 had urge ncy. Quality of life, rated on a scale of 0 to 10, was 7 or above in 4 4 of 48 assessed patients. Quality of health was rated 7 or higher in all 48 patients, energy level was 7 or higher in 39 patients, and over all happiness with surgery was 7 or higher in 47 patients. CONCLUSION: Colectomy and IRA is a relatively safe operation that results in mini mum disturbance of boa el function. Patient satisfaction is usually hi gh. Prophylactic colectomy can be offered to HNPCC gene carriers with a greater understanding of the likely outcome of surgery.