TY - JOUR
T1 - Colectomy and desmoid tumours in familial adenomatous polyposis
T2 - a systematic review and meta-analysis
AU - Aelvoet, Arthur S.
AU - Struik, Daphne
AU - Bastiaansen, Barbara A. J.
AU - Bemelman, Willem A.
AU - Hompes, Roel
AU - Bossuyt, Patrick M. M.
AU - Dekker, Evelien
N1 - Funding Information: Arthur S. Aelvoet: none to declare. Daphne Struik: none to declare. Barbara A.J. Bastiaansen: speakers' fee from Olympus, Tillotts Pharma AG and Ovesco Endoscopy AG. Willem A. Bemelman: VIFOR research grants, Takeda, Braun and Johnson consulting and speakers fee. Roel Hompes: none to declare. Patrick M.M. Bossuyt: none to declare. Evelien Dekker: endoscopic equipment on loan of FujiFilm and Olympus, receive a research grant from FujiFilm. I have received honorarium for consultancy from FujiFilm, Olympus, Tillots, GI Supply, CPP-FAP, PAION and Ambu, and speakers' fees from Olympus, Roche, GI Supply, Norgine and FujiFilm. Publisher Copyright: © 2022, The Author(s).
PY - 2022/10
Y1 - 2022/10
N2 - Abstract: Desmoid tumours (DT) are one of the main causes of death in patients with familial adenomatous polyposis (FAP). Surgical trauma is a risk factor for DT, yet a colectomy is inevitable in FAP to prevent colorectal cancer. This systematic review and meta-analysis aimed to synthesize the available evidence on DT risk related to type, approach and timing of colectomy. A search was performed in MEDLINE, EMBASE and the Cochrane Library. Studies were considered eligible when DT incidence was reported after different types, approaches and timing of colectomy. Twenty studies including 6452 FAP patients were selected, all observational. No significant difference in DT incidence was observed after IRA versus IPAA (OR 0.99, 95% CI 0.69–1.42) and after open versus laparoscopic colectomy (OR 0.88, 95% CI 0.42–1.86). Conflicting DT incidences were seen after early versus late colectomy and when analysing open versus laparoscopic colectomy according to colectomy type. Three studies reported a (non-significantly) higher DT incidence after laparoscopic IPAA compared to laparoscopic IRA, with OR varying between 1.77 and 4.09. A significantly higher DT incidence was observed in patients with a history of abdominal surgery (OR 3.40, 95% CI 1.64–7.03, p = 0.001). Current literature does not allow to state firmly whether type, approach, or timing of colectomy affects DT risk in FAP patients. Fewer DT were observed after laparoscopic IRA compared to laparoscopic IPAA, suggesting laparoscopic IRA as the preferred choice if appropriate considering rectal polyp burden. PROSPERO registration number: CRD42020161424.
AB - Abstract: Desmoid tumours (DT) are one of the main causes of death in patients with familial adenomatous polyposis (FAP). Surgical trauma is a risk factor for DT, yet a colectomy is inevitable in FAP to prevent colorectal cancer. This systematic review and meta-analysis aimed to synthesize the available evidence on DT risk related to type, approach and timing of colectomy. A search was performed in MEDLINE, EMBASE and the Cochrane Library. Studies were considered eligible when DT incidence was reported after different types, approaches and timing of colectomy. Twenty studies including 6452 FAP patients were selected, all observational. No significant difference in DT incidence was observed after IRA versus IPAA (OR 0.99, 95% CI 0.69–1.42) and after open versus laparoscopic colectomy (OR 0.88, 95% CI 0.42–1.86). Conflicting DT incidences were seen after early versus late colectomy and when analysing open versus laparoscopic colectomy according to colectomy type. Three studies reported a (non-significantly) higher DT incidence after laparoscopic IPAA compared to laparoscopic IRA, with OR varying between 1.77 and 4.09. A significantly higher DT incidence was observed in patients with a history of abdominal surgery (OR 3.40, 95% CI 1.64–7.03, p = 0.001). Current literature does not allow to state firmly whether type, approach, or timing of colectomy affects DT risk in FAP patients. Fewer DT were observed after laparoscopic IRA compared to laparoscopic IPAA, suggesting laparoscopic IRA as the preferred choice if appropriate considering rectal polyp burden. PROSPERO registration number: CRD42020161424.
KW - Colectomy
KW - Desmoid tumours
KW - Familial adenomatous polyposis
KW - Meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85122830349&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s10689-022-00288-y
DO - https://doi.org/10.1007/s10689-022-00288-y
M3 - Review article
C2 - 35022961
SN - 1389-9600
VL - 21
SP - 429
EP - 439
JO - Familial Cancer
JF - Familial Cancer
IS - 4
ER -