Prophylactic Colorectal Surgery in Familial Adenomatous Polyposis: Surgical Indications
In familial adenomatous polyposis (FAP), the risk of colorectal malignancy is determined by polyp burden and genotype. Identifying the threshold at which prophylactic surgery is indicated is essential to guide timing and operative planning.
Indications for Prophylactic Surgery
Prophylactic colorectal surgery is indicated in FAP when any of the following criteria are met:
- 20 or more rectal adenomas
- Approximately 500 or more colonic adenomas
- APC mutation at codon 1250–1450
Surgical Approach
The recommended approach involves prophylactic resection of the large intestine with restorative reconstruction — a specific surgical procedure is indicated in this setting.…
References
DOI: 10.1093/bjs/znae263
IPAA may be offered to patients with either: 20 or more rectal adenomas. Approximately 500 or more colonic adenomas. APC mutation at codon 1250–1450.
The two main options for prophylactic removal of the large intestine are colectomy with ileorectal anastomosis (IRA) and proctocolectomy with ileal pouch–anal anastomosis (IPAA).
Propose total proctocolectomy with IPAA.
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