The Occurrence of Carcinoma of the Rectum Following lleoproctostomy for Familial Polyposis

Abstract

Ileoproctostomy was performed in 32 patients (13 female and 19 male), with polyposis coli ranging in age from 10-54 yr. Seven patients (22%) developed cancer of the retained rectum with a median follow-up of 14 yr. Two (20%) of 10 patients, followed for 10-15 yr, and 3 (50%) of 6 patients, followed for 15-20 yr, developed rectal cancer. Rectal cancer developed in 2 of 14 patients who had their ileoproctostomy at 14 cm and in 5 of 18 patients who had their ileoproctostomy at a higher level, with a median followup of 7 and 11 yr, respectively. Rectal cancer developed in 2 of 15 teenage patients undergoing ileoproctostomy and in 9 of 17 patients aged 20-54 yr. The present average ages of the 2 groups were 25 and 41 yr, and the average age at which rectal cancer appeared was 40 yr. Three of the patients who developed rectal cancer had numerous polypectomies over the yr, and there was a tendency to develop tubulovillous and villous adenomas with a variable degree of atypia leading to carcinoma. One patient also showed a return to high levels of coprostanol and secondary fecal bile acids. Proctocolectomy, if acceptable, may be the treatment of choice; ileoproctostomy may mean that the patient eventually will undergo a protectomy. The ileoanal endorectal pull-through procedure has a great deal to offer to these patients, and further study is necessary to evaluate this procedure.