# Ileal pouch-anal anastomosis in familial adenomatous polyposis and ulcerative colitis with coexisting colorectal cancer: a guideline for treatment

## TL;DR

This paper provides guidelines for using ileal pouch-anal anastomosis in patients with colorectal cancer linked to familial adenomatous polyposis or ulcerative colitis.

## Contribution

The study offers a treatment guideline for IPAA in CRC patients with FAP or UC based on tumor stage and location.

## Key findings

- IPAA is feasible for stage I/II CRC regardless of tumor location.
- Stage III rectal cancer more than 2 cm from the dentate line can be treated with IPAA after total neoadjuvant treatment.
- IPAA is contraindicated in cases with severe proctitis due to bleeding or radiation risks.

## Abstract

Patients with familial adenomatous polyposis (FAP) or ulcerative colitis (UC) are at increased risk of colorectal cancer (CRC), making surgical decision-making complex. This case series reviews six patients with FAP or UC who developed CRC and underwent ileal pouch-anal anastomosis (IPAA). Two patients with stage III CRC developed metastases, while the remaining four with stage I/II had no recurrence. IPAA is feasible in stage I/II CRC regardless of tumor location. For stage III colon cancer, total proctocolectomy (TPC) with IPAA followed by adjuvant chemotherapy is appropriate. In stage III rectal cancer more than 2 cm from the dentate line, IPAA can follow total neoadjuvant treatment (TNT). For tumors within 2 cm of the dentate line, TPC with end ileostomy is advised. IPAA may be contraindicated in cases with severe proctitis due to bleeding risk or radiation intolerance. Overall, IPAA is a suitable option for selected FAP or UC patients with CRC.