Download PDF
CC BY 4.0 · Endosc Int Open 2024; 12(05): E659-E665
DOI: 10.1055/a-2298-0038
Original article

Outcomes following duodenectomy in patients with familial adenomatous polyposis

Arthur S. Aelvoet 
1   Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands (Ringgold ID: RIN1209)
2   Cancer Center Amsterdam, Amsterdam, the Netherlands (Ringgold ID: RIN571143)
3   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands (Ringgold ID: RIN571165)
,
Isabel Martin 
4   Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom (Ringgold ID: RIN105692)
5   Department of Surgery and Cancer, Imperial College, London, United Kingdom Ireland (Ringgold ID: RIN4615)
,
James Cockburn
4   Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom (Ringgold ID: RIN105692)
,
Cherryl Cabalit
4   Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom (Ringgold ID: RIN105692)
,
Victoria Cuthill
4   Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom (Ringgold ID: RIN105692)
,
Duncan Spalding
5   Department of Surgery and Cancer, Imperial College, London, United Kingdom Ireland (Ringgold ID: RIN4615)
,
Olivier Busch
2   Cancer Center Amsterdam, Amsterdam, the Netherlands (Ringgold ID: RIN571143)
6   Department of Surgery, Amsterdam UMC location, Amsterdam, the Netherlands (Ringgold ID: RIN1209)
,
Barbara A.J. Bastiaansen 
1   Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands (Ringgold ID: RIN1209)
2   Cancer Center Amsterdam, Amsterdam, the Netherlands (Ringgold ID: RIN571143)
3   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands (Ringgold ID: RIN571165)
,
Susan K. Clark
4   Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom (Ringgold ID: RIN105692)
5   Department of Surgery and Cancer, Imperial College, London, United Kingdom Ireland (Ringgold ID: RIN4615)
,
Evelien Dekker 
1   Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands (Ringgold ID: RIN1209)
2   Cancer Center Amsterdam, Amsterdam, the Netherlands (Ringgold ID: RIN571143)
3   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands (Ringgold ID: RIN571165)
,
Andrew Latchford 
4   Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom (Ringgold ID: RIN105692)
5   Department of Surgery and Cancer, Imperial College, London, United Kingdom Ireland (Ringgold ID: RIN4615)
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Some patients with familial adenomatous polyposis (FAP) and extensive duodenal polyposis or cancer require total duodenectomy. Regular postoperative endoscopic surveillance of the remaining jejunum and stomach is recommended, but little is known about the outcomes after this surgery.

Patients and methods Patients with FAP who underwent either pancreatoduodenectomy (PD) or pancreas-preserving total duodenectomy (PPTD) were identified at two expert centers. Data about postoperative endoscopic surveillance outcomes were collected, as well as survival outcomes.

Results Overall, 119 patients (50% female) underwent duodenectomy (86 PD and 33 PPTD); 100 for benign duodenal polyposis and 19 for duodenal or ampullary cancer. Details of postoperative endoscopic surveillance were available for 88 patients (74%). During a median follow-up of 106 months, 36 patients (41%) were diagnosed with jejunal adenomas after duodenectomy, with a significantly higher proportion in patients who underwent PPTD compared with patients who underwent PD (log-rank, P < 0.01). Two patients developed jejunal cancer (2%). Twenty-six patients (30%) were diagnosed with a total of 66 gastric adenomas, of which 61% were located in the fundus/body and 39% in the antrum. Five patients (6%) developed gastric cancer after a median of 15 years (range 6–23 years), all but one within carpeting fundic gland polyposis. Patients who underwent surgery for cancer had worse survival than patients with benign disease and all but one patient with postoperative gastric/jejunal cancer died.

Conclusions After duodenectomy in FAP, a considerable risk of developing adenomas and cancer in the stomach and jejunum exists with poor cancer prognosis, highlighting the need for close postoperative endoscopic surveillance.

Keywords

Familial adenomatous polyposis - duodenal surgery - endoscopic surveillance - gastric neoplasia - jejunal neoplasia


Publication History

Received: 31 October 2023

Accepted after revision: 27 February 2024

Accepted Manuscript online:
02 April 2024

Article published online:
03 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2024; 56(07): 555-555
DOI: 10.1055/a-2280-6811

 

  • References

  • 1 Anele CC, Xiang J, Martin I. et al. Regular endoscopic surveillance and polypectomy is effective in managing rectal adenoma progression following colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis. Colorectal Dis 2022; 24: 277-283
    CrossrefPubMedSearch in Google Scholar
  • 2 Pasquer A, Benech N, Pioche M. et al. Prophylactic colectomy and rectal preservation in FAP: systematic endoscopic follow-up and adenoma destruction changes natural history of polyposis. Endosc Int Open 2021; 9: E1014-E1022
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Ghorbanoghli Z, Bastiaansen BA, Langers AM. et al. Extracolonic cancer risk in Dutch patients with APC (adenomatous polyposis coli)-associated polyposis. J Med Genetics 2018; 55: 11-14
    CrossrefPubMedSearch in Google Scholar
  • 4 Björk J, Akerbrant H, Iselius L. et al. Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis: cumulative risks and APC gene mutations. Gastroenterology 2001; 121: 1127-1135
    CrossrefPubMedSearch in Google Scholar
  • 5 Lepistö A, Kiviluoto T, Halttunen J. et al. Surveillance and treatment of duodenal adenomatosis in familial adenomatous polyposis. Endoscopy 2009; 41: 504-509
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Wallace MH, Phillips RK. Upper gastrointestinal disease in patients with familial adenomatous polyposis. Br J Surg 1998; 85: 742-750
    CrossrefPubMedSearch in Google Scholar
  • 7 van Leerdam ME, Roos VH, van Hooft JE. et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877-895
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Takeuchi Y, Hamada K, Nakahira H. et al. Efficacy and safety of intensive downstaging polypectomy (IDP) for multiple duodenal adenomas in patients with familial adenomatous polyposis: a prospective cohort study. Endoscopy 2023; 55: 515-523
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Aelvoet AS, Bastiaansen BAJ, Fockens P. et al. Pancreas-preserving total duodenectomy for advanced duodenal polyposis in patients with familial adenomatous polyposis: short and long-term outcomes. HPB (Oxford) 2022; 24: 1642-1650
    CrossrefPubMedSearch in Google Scholar
  • 10 Yoon JY, Mehta N, Burke CA. et al. The prevalence and significance of jejunal and duodenal bulb polyposis after duodenectomy in familial adenomatous polyposis: retrospective cohort study. Ann Surg 2021; 274: e1071-e1077
    CrossrefPubMedSearch in Google Scholar
  • 11 Martin I, Roos VH, Anele C. et al. Gastric adenomas and their management in familial adenomatous polyposis. Endoscopy 2021; 53: 795-801
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Mankaney G, Leone P, Cruise M. et al. Gastric cancer in FAP: a concerning rise in incidence. Fam Cancer 2017; 16: 371-376
    CrossrefPubMedSearch in Google Scholar
  • 13 Naples R, Simon R, Moslim M. et al. Long-term outcomes of pancreas-sparing duodenectomy for duodenal polyposis in familial adenomatous polyposis syndrome. J Gastrointest Surg 2021; 25: 1233-1240
    CrossrefPubMedSearch in Google Scholar
  • 14 Alderlieste YA, Bastiaansen BA, Mathus-Vliegen EM. et al. High rate of recurrent adenomatosis during endoscopic surveillance after duodenectomy in patients with familial adenomatous polyposis. Fam Cancer 2013; 12: 699-706
    CrossrefPubMedSearch in Google Scholar
  • 15 Mahmoud NN, Dannenberg AJ, Bilinski RT. et al. Administration of an unconjugated bile acid increases duodenal tumors in a murine model of familial adenomatous polyposis. Carcinogenesis 1999; 20: 299-303
    CrossrefPubMedSearch in Google Scholar
  • 16 Parc Y, Desaint B, Fléjou JF. et al. The effect of ursodesoxycholic acid on duodenal adenomas in familial adenomatous polyposis: a prospective randomized placebo-control trial. Colorectal Dis 2012; 14: 854-860
    CrossrefPubMedSearch in Google Scholar
  • 17 Mabrut JY, Romagnoli R, Collard JM. et al. Familial adenomatous polyposis predisposes to pathologic exposure of the stomach to bilirubin. Surgery 2006; 140: 818-823
    CrossrefPubMedSearch in Google Scholar
  • 18 Zhang LY, Zhang J, Li D. et al. Bile reflux is an independent risk factor for precancerous gastric lesions and gastric cancer: An observational cross-sectional study. J Dig Dis 2021; 22: 282-290
    CrossrefPubMedSearch in Google Scholar
  • 19 Jagelman DG, DeCosse JJ, Bussey HJ. Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1988; 1: 1149-1151
    CrossrefPubMedSearch in Google Scholar
  • 20 Campos FG, Martinez CAR, Sulbaran M. et al. Upper gastrointestinal neoplasia in familial adenomatous polyposis: prevalence, endoscopic features and management. J Gastrointest Oncol 2019; 10: 734-744
    CrossrefPubMedSearch in Google Scholar
  • 21 Alderlieste YA, Rauws EA, Mathus-Vliegen EM. et al. Prospective enteroscopic evaluation of jejunal polyposis in patients with familial adenomatous polyposis and advanced duodenal polyposis. Fam Cancer 2013; 12: 51-56
    CrossrefPubMedSearch in Google Scholar
  • 22 Spigelman AD, Williams CB, Talbot IC. et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989; 2: 783-785
    CrossrefPubMedSearch in Google Scholar
  • 23 Aelvoet AS, Pellisé M, Bastiaansen BAJ. et al. Personalized endoscopic surveillance and intervention protocols for patients with familial adenomatous polyposis: the European FAP Consortium strategy. Endosc International Open 2023; 11: E386-E393
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Leone PJ, Mankaney G, Sarvapelli S. et al. Endoscopic and histologic features associated with gastric cancer in familial adenomatous polyposis. Gastrointest Endosc 2019; 89: 961-968
    CrossrefPubMedSearch in Google Scholar