PURPOSE: Precancerous duodenal lesions in patients with familial adenomatous polyposis can be detected with duodenoscopy and treatment may prevent the development of cancer. We proposed to determine the frequency, natural history, cumulative risk, and risk factors of the precancerous duodenal lesions in a series of patients diagnosed in northern Italy. METHODS: A prospective, endoscopic, follow-up protocol was performed in 50 patients examined by gastroduodenoscopy at two years of interval or less. The presence and severity of precancerous lesions of the duodenal mucosa were evaluated by Spigelman score. Twenty-five patients (50 percent) had proctocolectomy and ileoanal anastomosis, 15 (30 percent) had colectomy and ileorectal anastomosis, and 5 (10 percent) had proctocolectomy and definitive ileostomy from 0 to 3 years before the admission to the surveillance program. All patients showed more than a thousand adenomas in the colorectal mucosa. No patients with attenuated polyposis were found. RESULTS: At the first endoscopy, duodenal adenomas could be detected in 19 of 50 patients (38 percent), whereas at the end of the follow-up, 43 (86 percent) had duodenal lesions. The final mean Spigelman score increased during the follow-up period (P < 0.001 respect to baseline values). No duodenal cancer could be detected. Eleven patients had or developed severe precancerous duodenal lesions (Stage IV) treated with endoscopic or surgical resection. The distribution of patients with Stage IV according to the surgery of the colon was: 2 of 25 treated with ileoanal anastomosis and 8 of 15 with ileorectal anastomosis (P=0.0024, Fisher's exact test). CONCLUSIONS: Patients with familial adenomatous polyposis are at risk of significant neoplasia. The natural history of precancerous lesions might be related to surgical treatment of colorectal neoplasms.

Impact of surgery on the development of duodenal cancer in patients with familial adenomatous polyposis / Biasco, G; Nobili, E; Calabrese, C; Sassatelli, R; Camellini, L; Pantaleo, Ma; Bertoni, G; De Vivo, A; PONZ DE LEON, Maurizio; Poggioli, G; Bedogni, G; Venesio, T; Varesco, L; Risio, M; Di Febo, G; Brandi, G.. - In: DISEASES OF THE COLON & RECTUM. - ISSN 0012-3706. - STAMPA. - 49(2006), pp. 1860-1866.

Impact of surgery on the development of duodenal cancer in patients with familial adenomatous polyposis

PONZ DE LEON, Maurizio;
2006

Abstract

PURPOSE: Precancerous duodenal lesions in patients with familial adenomatous polyposis can be detected with duodenoscopy and treatment may prevent the development of cancer. We proposed to determine the frequency, natural history, cumulative risk, and risk factors of the precancerous duodenal lesions in a series of patients diagnosed in northern Italy. METHODS: A prospective, endoscopic, follow-up protocol was performed in 50 patients examined by gastroduodenoscopy at two years of interval or less. The presence and severity of precancerous lesions of the duodenal mucosa were evaluated by Spigelman score. Twenty-five patients (50 percent) had proctocolectomy and ileoanal anastomosis, 15 (30 percent) had colectomy and ileorectal anastomosis, and 5 (10 percent) had proctocolectomy and definitive ileostomy from 0 to 3 years before the admission to the surveillance program. All patients showed more than a thousand adenomas in the colorectal mucosa. No patients with attenuated polyposis were found. RESULTS: At the first endoscopy, duodenal adenomas could be detected in 19 of 50 patients (38 percent), whereas at the end of the follow-up, 43 (86 percent) had duodenal lesions. The final mean Spigelman score increased during the follow-up period (P < 0.001 respect to baseline values). No duodenal cancer could be detected. Eleven patients had or developed severe precancerous duodenal lesions (Stage IV) treated with endoscopic or surgical resection. The distribution of patients with Stage IV according to the surgery of the colon was: 2 of 25 treated with ileoanal anastomosis and 8 of 15 with ileorectal anastomosis (P=0.0024, Fisher's exact test). CONCLUSIONS: Patients with familial adenomatous polyposis are at risk of significant neoplasia. The natural history of precancerous lesions might be related to surgical treatment of colorectal neoplasms.
49
1860
1866
Impact of surgery on the development of duodenal cancer in patients with familial adenomatous polyposis / Biasco, G; Nobili, E; Calabrese, C; Sassatelli, R; Camellini, L; Pantaleo, Ma; Bertoni, G; De Vivo, A; PONZ DE LEON, Maurizio; Poggioli, G; Bedogni, G; Venesio, T; Varesco, L; Risio, M; Di Febo, G; Brandi, G.. - In: DISEASES OF THE COLON & RECTUM. - ISSN 0012-3706. - STAMPA. - 49(2006), pp. 1860-1866.
Biasco, G; Nobili, E; Calabrese, C; Sassatelli, R; Camellini, L; Pantaleo, Ma; Bertoni, G; De Vivo, A; PONZ DE LEON, Maurizio; Poggioli, G; Bedogni, G; Venesio, T; Varesco, L; Risio, M; Di Febo, G; Brandi, G.
File in questo prodotto:
File Dimensione Formato  
Impact of surgery on development of duodenal cancer Biasco et al.pdf

non disponibili

Tipologia: Post-print dell'autore (bozza post referaggio)
Dimensione 2.31 MB
Formato Adobe PDF
2.31 MB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11380/307333
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 3
  • ???jsp.display-item.citation.isi??? 3
social impact