# Improved outcomes in Familial Adenomatous polyposis management. Results achieved in a single center over a 40-year period

## TL;DR

Over 40 years, earlier diagnosis and better surgical techniques significantly improved outcomes for Familial Adenomatous Polyposis patients.

## Contribution

The study demonstrates long-term improvements in FAP management through early diagnosis, prophylactic surgery, and laparoscopic techniques.

## Key findings

- Earlier diagnosis and treatment led to a significant reduction in colorectal cancer incidence.
- Laparoscopic surgery became the most common approach, improving outcomes and reducing complications.
- Family-based screening increased, contributing to better long-term survival and quality of life.

## Abstract

•Adenomatous polyposis must be diagnosed and treated before colorectal cancer develops.•Screening and prophylactic surgery may improve quality of life and survival.•A review of a 40-year experience demonstrated excellent results and improvement in FAP management.

Adenomatous polyposis must be diagnosed and treated before colorectal cancer develops.

Screening and prophylactic surgery may improve quality of life and survival.

A review of a 40-year experience demonstrated excellent results and improvement in FAP management.

Long-term Familial Adenomatous Polyposis (FAP) outcomes depend on timely diagnosis and treatment.

To analyse the experience in FAP management over a 40-year period.

Charts 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).

176 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.

Comparison 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.