Desmoid tumors (DT) are an important cause of morbidity and mortality in patients with familial adenomatous polyposis (FAP). DT development might be related to the type and approach of colectomy. We aimed to compare DT development after colectomy with ileorectal anastomosis (IRA) and proctocolectomy with ileal pouch-anal anastomosis (IPAA). We performed an international historical cohort study in patients with FAP who underwent IRA or IPAA between 1961 and 2020. The primary outcome was the incidence of abdominal DT (either mesenteric, retroperitoneal, or abdominal wall). Patients with a DT diagnosis before or at colectomy were excluded. Time to DT was considered censored at an eventual secondary proctectomy after IRA. We used multivariable Cox regression modelling to adjust for potential confounders. We analyzed data from 852 patients: 514 after IRA and 338 after IPAA (median follow-up, 21 and 16 years, respectively). DTs were diagnosed in 64 IRA patients (12%) and 66 IPAA patients (20%). The cumulative DT incidence at 5 and 10 years was 7.5% and 9.3% after open IRA and 4.7% and 10.9% after laparoscopic IRA. These estimates were 13.6% and 15.4% after open IPAA and 8.4% and 10.0% after laparoscopic IPAA. The postoperative risk was significantly higher after IPAA ( < .01) in multivariable analysis, whereas approach did not significantly influence the risk. The risk of developing an abdominal DT was found to be significantly higher after IPAA than after IRA. Postoperative DT risk should be taken into account when choosing between IRA and IPAA in FAP.

中文翻译：

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家族性腺瘤性息肉病中回肠直肠吻合术后硬纤维瘤的发展与回肠袋肛门吻合术


硬纤维瘤 （DT） 是家族性腺瘤性息肉病 （FAP） 患者发病和死亡的重要原因。DT 的发生可能与结肠切除术的类型和方法有关。我们旨在比较结肠切除术与回肠直肠吻合术 （IRA） 和直肠结肠切除术与回肠贮袋肛门吻合术 （IPAA） 后的 DT 发展。我们对 1961 年至 2020 年间接受 IRA 或 IPAA 的 FAP 患者进行了一项国际历史队列研究。主要结局是腹部 DT （肠系膜、腹膜后或腹壁） 的发生率。排除了结肠切除术前或结肠切除术时诊断为 DT 的患者。在 IRA 后的最终二次直肠切除术中，DT 时间被认为截尾。我们使用多变量 Cox 回归模型来调整潜在的混杂因素。我们分析了 852 名患者的数据： IRA 后 514 名，IPAA 后 338 名 （中位随访分别为 21 年和 16 年）。64 例 IRA 患者 （12%） 和 66 例 IPAA 患者 （20%） 诊断出 DTs。开放 IRA 后 5 年和 10 年的累积 DT 发生率分别为 7.5% 和 9.3%，腹腔镜 IRA 后分别为 4.7% 和 10.9%。这些估计值在开放 IPAA 后为 13.6% 和 15.4%，腹腔镜 IPAA 后为 8.4% 和 10.0%。在多变量分析中，IPAA 后术后风险显著升高 （ < .01），而方法对风险没有显著影响。发现 IPAA 后发生腹部 DT 的风险显著高于 IRA 后。在 FAP 中选择 IRA 和 IPAA 时，应考虑术后 DT 风险。