ArticleClinics (Sao Paulo, Brazil)
Improved outcomes in Familial Adenomatous polyposis management. Results achieved in a single center over a 40-year period.
Article in Clinics (Sao Paulo, Brazil). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionLong-term Familial Adenomatous Polyposis (FAP) outcomes depend on timely diagnosis and treatment. PURPOSE: To analyse the experience in FAP management over a 40-year period. MATERIAL AND
methodsCharts from FAP patients (1982‒2023 were reviewed. Demographic data and surgical outcomes were compared between an early (1982 to 2006) and a recent period (2007 to 2023).
results176 FAP patients were identified. Mean age at treatment (35.6 vs. 29.7), at diagnosis (35.6 vs. 29.7), and younger than 30-years (30.6 % vs. 50 %) showed that most patients were diagnosed earlier in the recent period. The authors detected a reduction of asymptomatic patients (93.5 % vs. 59.5 %, p = 0.0001) and symptoms duration (21.5 vs. 10.6 months, p = 0.0001). Simultaneously, both polyposis diagnoses were motivated by family clustering (26.1 % to 57.1 %, p = 0.02) and not associated with CRC (40.2 % to 67.8 %, p = 0.003) increased. Global CRC incidence decreased from 59.7 % to 32.1 % (p = 0.003). Gradually, pouch surgery (69 %) and the laparoscopic approach (92.7 %) turned out to be the most frequent surgical choices. Long-term mortality also diminished (19.5 % to 9.5 %) mainly due to fewer deaths resulting from CRC (11.9 % to 4.8 %). Diagnosis of desmoid disease (9.8 % to 22.6 %) and duodenal cancer (8.7 % to 2.4 %) changed differently.
conclusionsComparison of outcomes during a 40-year period revealed a clear improvement in FAP management. This scenario resulted from 1) Continuous orientation to family members to advise an earlier diagnosis; 2) Prophylactic surgical treatment with reduced CRC association, and 3) Increased use of laparoscopic techniques with less morbidity and better outcomes.
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