Surgical Options for Familial Adenomatous Polyposis

Familial adenomatous polyposis (FAP) is caused by a mutation of APC gene. The use of prophylactic surgery has significantly changed patients’ destiny, avoiding the development of colorectal cancer. It is now clear that the different patterns of FAP are based on different APC mutations. For this reason, it is important to offer a tailored approach, where the type of operation and the timing is based on aggressiveness of the disease and the risk of other manifestations such as desmoid tumors. Furthermore, it is also important to take into account the wishes and expectations of these patients. For example, we are increasingly coming across asymptomatic young women with FAP who want to have children and who are worried about the consequences of surgery for pregnancy. The decision process is not always easy, especially since there is often not a unique right answer. The final choice should often be taken by the patients, guided but not forced by the surgeon.