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  • Title: Does intra-abdominal desmoid disease affect patients with an ileal pouch differently than those with an ileorectal anastomosis?
    Author: Burgess A, Xhaja X, Church J.
    Journal: Dis Colon Rectum; 2011 Nov; 54(11):1388-91. PubMed ID: 21979183.
    Abstract:
    BACKGROUND: Nobody has analyzed the sequelae of desmoids according to the type of surgery that precipitated them. OBJECTIVE: This study aims to determine whether the clinical effects of abdominal desmoids would be worse in patients with restorative proctocolectomy than in patients with ileorectal anastomosis. DESIGN: This is a retrospective, database study. PATIENTS: Included were patients with familial adenomatous polyposis who had undergone proctocolectomy with IPAA or colectomy and ileorectal anastomosis, and subsequently developed an intra-abdominal desmoid tumor. MAIN OUTCOME MEASURES: The primary outcome measures were the clinical course of the desmoids; morbidity, and the requirement for stoma. RESULTS: There were 86 patients: 49 had restorative proctocolectomy and 37 had ileorectal anastomosis. Patient demographics were similar. Average follow-up was 9.8 years (range, 2.7-23.8) and 16.3 years (range, 2.3 - 42.9). Treatment of the desmoids included surgery (64.4% vs 65.6%), medical therapy (69.4% vs 59.5%), chemotherapy (36.2% vs 30.0%), and radiotherapy (4.5% vs 10.0%), and was the same for each group. The overall complication rate of desmoids was similar, approaching 70%. The risk of individual complications was also similar (bleeding (2.0% vs 0.0%), fistula (10.2% vs 13.5%), bowel obstruction (32.7% vs 48.6%), pain (34.7% vs 21.6%), and death related to desmoid tumors (2.0% vs 10.8%)); 38.8% of the restorative proctocolectomy group and 51.4% the ileorectal group had surgery for desmoid tumor complications (P = .21), and 22.4% and 22.2% of patients ultimately had permanent stomas. LIMITATIONS: This study was limited by the relatively small numbers of patients. CONCLUSION: The morbidity associated with desmoid tumors has not been shown to differ, whether they arise after restorative proctocolectomy or ileorectal anastomosis.
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