Quality of Life and Familial Adenomatous Polyposis Patients

Abstract

Qualty of life (QoL) has become one of the main goals of surgery for familial adenomatous polyposis (FAP). Patients with FAP are usually young and asymptomatic, so the ideal surgery should combine the lowest risk of cancer with the minimum impact to lifestyle and activity. For these reasons restorative proctocolectomy (RPC) with ileo-anal pouch anastomosis (IPAA) has been the gold standard for FAP patients in the last two decades. Many studies report good overall rates of QoL after IPAA. Nevertheless, this surgery is complicated by functional problems, particularly in terms of high frequency of bowel movements, episodes of incontinence (especially mild or soiling in the night time), diet limitations, and, although it usually does not affect social and work life, IPAA can potentially lead to sexual problems; furthermore, there is a significant decrease of fertility in women after IPAA. These considerations lead many authors to reconsider the possibility of FAP patients undergoing ileorectal anastomosis (IRA); this surgery has better functional results and can almost always be converted into secondary IPAA. Nevertheless, IRA necessitates a strict follow-up that can detect but not prevent neoplastic degeneration. Moreover, there is still not a clear superiority of IRA over IPAA in terms of QoL. Since QoL is highly dependent on the patient’s participation and wishes, in combination with surgical outcomes and need for further follow-up, surgery must be discussed and planned with the patients themselves.