Prophylactic Colorectal Surgery in FAP with Low Rectal Adenoma Burden

In familial adenomatous polyposis (FAP), colonoscopic findings directly determine the timing and nature of prophylactic surgery. When the adenoma burden meets specific thresholds, a defined surgical pathway applies.

Clinical Scenario

This protocol is indicated when colonoscopy confirms 5 or fewer rectal adenomas and fewer than 500 colonic adenomas. This distribution qualifies the patient for prophylactic colorectal surgery and informs the choice between available surgical approaches.

Surgical Approach — Partial Overview

Prophylactic removal of the large intestine is the indicated course of action. The approach centres on a colectomy — the structured protocol defines which procedure is recommended for this adenoma profile and under what conditions an alternative may be considered.

Procedure selection criteria, alternatives, and the complete decision framework are available in the full protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/bjs/znae263

IRA may be offered to: Patients with 5 or fewer rectal adenomas and less than 500 colonic adenomas.
5 or fewer rectal adenomas AND fewer than 500 colonic adenomas.
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 colectomy with IRA or near total colectomy.

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