Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Comparison of the outcomes of ileal pouch-anal anastomosis and ileorectal anastomosis for patients with familial adenomatous polyposis: a systematic review and meta-analysis.
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Tang Phuong Minh, Vo Bui Thien Nghiep, Chang Tung-Cheng, Loh El-Wui, Tam Ka-Wai
Аннотация
BACKGROUND: Familial adenomatous polyposis (FAP) is an inherited colorectal cancer syndrome for which ileorectal anastomosis (IRA) preserves the rectum, but ileal pouch-anal anastomosis (IPAA) removes it. These procedures may influence the risk of desmoid tumors and involve trade-offs between oncologic protection and bowel function. This study compares the oncologic, desmoid, functional, and postoperative outcomes of IRA and IPAA in FAP.
METHODS: PubMed, Embase, Scopus, and the Cochrane Library were searched for relevant studies. The primary outcomes were rectal or pouch-anal cancer and desmoid tumors. The risk of bias was assessed using the Risk of Bias In Non-randomized Studies of Interventions tool and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Random-effects meta-analyzes were conducted using pooled risk ratios (RRs), mean differences (MDs), and hazard ratios.
RESULTS: Thirty-four studies involving 4700 patients were included. Compared with IRA, IPAA was associated with lower risks of postoperative rectal and pouch-anal cancer (RR, 0.22; 95% CI, 0.09-0.54) but with a higher risk of desmoid tumors (RR, 1.58; 95% CI, 1.13-2.19). IPAA was associated with higher rates of 24-hour incontinence (RR, 1.90; 95% CI, 1.24-2.92) and greater 24-hour stool frequency (MD, 1.89 stools/d; 95% CI, 1.29-2.49). Anastomotic stricture was more frequent after IPAA (RR, 2.91; 95% CI, 1.46-5.78), but major complications did not differ substantially between the procedures.
CONCLUSION: IPAA is associated with greater long-term oncologic protection but worse bowel function and a higher desmoid tumor risk compared with IRA. These findings support individualized procedure selection based on surveillance feasibility to balance functional trade-offs, perioperative risks, and durability.
METHODS: PubMed, Embase, Scopus, and the Cochrane Library were searched for relevant studies. The primary outcomes were rectal or pouch-anal cancer and desmoid tumors. The risk of bias was assessed using the Risk of Bias In Non-randomized Studies of Interventions tool and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Random-effects meta-analyzes were conducted using pooled risk ratios (RRs), mean differences (MDs), and hazard ratios.
RESULTS: Thirty-four studies involving 4700 patients were included. Compared with IRA, IPAA was associated with lower risks of postoperative rectal and pouch-anal cancer (RR, 0.22; 95% CI, 0.09-0.54) but with a higher risk of desmoid tumors (RR, 1.58; 95% CI, 1.13-2.19). IPAA was associated with higher rates of 24-hour incontinence (RR, 1.90; 95% CI, 1.24-2.92) and greater 24-hour stool frequency (MD, 1.89 stools/d; 95% CI, 1.29-2.49). Anastomotic stricture was more frequent after IPAA (RR, 2.91; 95% CI, 1.46-5.78), but major complications did not differ substantially between the procedures.
CONCLUSION: IPAA is associated with greater long-term oncologic protection but worse bowel function and a higher desmoid tumor risk compared with IRA. These findings support individualized procedure selection based on surveillance feasibility to balance functional trade-offs, perioperative risks, and durability.