Table 1.

Indications, contraindications, advantages and disadvantages of surgical options for patients with FAP. Reproduced with permission of the authors: Smith et al., J Cancer Ther 2013;4:260–270.²⁷

Option	Indications	Contraindications	Advantages	Disadvantages
IRA	< 20 rectal adenomas < 1000 colonic adenomas^31,53,54,70	Severe dysplasia in the rectum Cancer anywhere in large bowel *Large (>3cm) rectal adenomas	Avoiding pelvic dissection²⁰ Simple surgery Lower complications Good functional results *No stoma⁵⁵	Retained rectum may need to be removed later Possibility of rectal cancer if patient is not compliant with follow-up
RPC with IPAA ■ Stapled or ■ Mucosectomv	> 20 rectal adenomas, >1000 colonic adenomas⁵³ Severe dysplasia in the rectum Cancer anywhere in large bowel Large (>3cm) rectal adenomas ATZ clear of adenomas	Incompetent sphincters Rectal cancer invading sphincters *Pouch won't reach anus	Avoid permanent stoma *Good function in most patients ⁷⁴	Higher complication rate May provoke desmoids Decreased ability to conceive in women.⁸⁰,⁸⁷ Retained anal and lower rectal mucosa may develop neoplasia (28%)⁴²
TPC & IL	> 20 rectal adenomas, >1000 colonic adenomas⁵³ Severe dysplasia in the rectum Cancer anywhere in large bowel Large (>3cm) rectal adenomas ATZ clear of adenomas Incompetent sphincters Rectal cancer invading sphincters *Pouch won't reach anus	* Avoids permanent stoma *Reasonable function in most patients. No residual anal mucosa (although neoplasia can still occur)^26,74	Avoids permanent stoma Reasonable function in most patients. No residual anal mucosa (although neoplasia can still occur)^26,74	Higher complication rate May provoke desmoids Decreased ability to conceive in women.^80,87 Retained anal and lower rectal mucosa may develop neoplasia (28%) Frequent seepage Night time incontinence.⁷⁴ *Anal neoplasia in 14%.⁴²
TPC with CIL (Kock)	> 20 rectal adenomas, >1000 colonic adenomas⁵³ Severe dysplasia in the rectum Cancer anywhere in large bowel Large (>3cm) rectal adenomas ATZ clear of adenomas Incompetent sphincters Rectal cancer invading sphincters Pouch won't reach anus	Competent sphincters No rectal cancer *Pouch reaches anus	Lower complication rate Lower chance of reoperation *No anal incontinence	*Permanent stoma

Abbreviation:

IRA = lleorectal anastomosis; RPC = Restorative proctocolectomy; IPAA = Meal pouch-anal anastomosis; TPC & IL = Proctocolectomy and lleostomy; TPC with CIL = Proctocolectomy with continent ileostomy (Kock); ATZ = anal transit zone

Option	Indications	Contraindications	Advantages	Disadvantages
IRA	< 20 rectal adenomas < 1000 colonic adenomas^31,53,54,70	Severe dysplasia in the rectum Cancer anywhere in large bowel *Large (>3cm) rectal adenomas	Avoiding pelvic dissection²⁰ Simple surgery Lower complications Good functional results *No stoma⁵⁵	Retained rectum may need to be removed later Possibility of rectal cancer if patient is not compliant with follow-up
RPC with IPAA ■ Stapled or ■ Mucosectomv	> 20 rectal adenomas, >1000 colonic adenomas⁵³ Severe dysplasia in the rectum Cancer anywhere in large bowel Large (>3cm) rectal adenomas ATZ clear of adenomas	Incompetent sphincters Rectal cancer invading sphincters *Pouch won't reach anus	Avoid permanent stoma *Good function in most patients ⁷⁴	Higher complication rate May provoke desmoids Decreased ability to conceive in women.⁸⁰,⁸⁷ Retained anal and lower rectal mucosa may develop neoplasia (28%)⁴²
TPC & IL	> 20 rectal adenomas, >1000 colonic adenomas⁵³ Severe dysplasia in the rectum Cancer anywhere in large bowel Large (>3cm) rectal adenomas ATZ clear of adenomas Incompetent sphincters Rectal cancer invading sphincters *Pouch won't reach anus	* Avoids permanent stoma *Reasonable function in most patients. No residual anal mucosa (although neoplasia can still occur)^26,74	Avoids permanent stoma Reasonable function in most patients. No residual anal mucosa (although neoplasia can still occur)^26,74	Higher complication rate May provoke desmoids Decreased ability to conceive in women.^80,87 Retained anal and lower rectal mucosa may develop neoplasia (28%) Frequent seepage Night time incontinence.⁷⁴ *Anal neoplasia in 14%.⁴²
TPC with CIL (Kock)	> 20 rectal adenomas, >1000 colonic adenomas⁵³ Severe dysplasia in the rectum Cancer anywhere in large bowel Large (>3cm) rectal adenomas ATZ clear of adenomas Incompetent sphincters Rectal cancer invading sphincters Pouch won't reach anus	Competent sphincters No rectal cancer *Pouch reaches anus	Lower complication rate Lower chance of reoperation *No anal incontinence	*Permanent stoma