Familial adenomatosis coli: surgical treatment with cellular transplantation
Abstract
Aim of investigation. To develop reconstructed mucosa of the rectum for improvement results of surgical treatment of familial adenomatosis polyposis coli (FAP).
Material and methods. Overall 27 patients with FAP underwent surgical treatment including colectomy, demucosation of rectum and allogenic transplantation of fetal intestinal epithelium cells and mesenchyma of various origin to develop reconstructed mucosa. In 5 patients the ileorectal anastomosis, in 22 – small-intestinal reservoirs were created.
Results. During period from 4 to 12 wks development of rectal mucosa was observed in all patients. At follow-up from 1 year to 5 years no proliferation of polyps was revealed in 26 (96,3%) patients.
Conclusions. Cell transplantation can successfully be applied for development of reconstructed rectal mucosa. Keeping part of rectum after colectomy and formation of smallintestinal reservoir allows to keep natural intestinal passage with good functional results.
About the Authors
Yu. A. ShelyginRussian Federation
A. M. Kuzminov
Russian Federation
D. V. Vyshegorodtsev
Russian Federation
L. L. Kapuller
Russian Federation
G. T. Sukhikh
Russian Federation
References
1. Воробьев Г.И. Основы колопроктологии: Учебное пособие. – Ростов н/Д: «Феникс», 2001. – С. 320–332.
2. Barton J.G., Paden M.A., Lane M., Postier R.G. Comparison of postoperative outcomes in ulcerative colitis and familial polyposis patients after ileoanal pouch operations // Am. J. Surg. – 2001. – Vol. 182. – P. 616–620.
3. Behrends J., Jerchow B.A., Wurtele M. et al. Functional interaction of an axon homolog, conductin, with b-catenin, APC, and GSK3 // Science. – 1998. – Vol. 280. – P. 596–599.
4. Bulow S. Familial polyposis // Dan. Med. Bull. – 1987. – Vol. 34. – P. 1–15.
5. Bussey H.J.R., Eyers A.A., Ritchie S.M., Thomson J.P.S. The rectum in adenomatous polyposis: The St-Mark`s policy // Br. J. Surg. – 1985. – Vol. 72 (suppl.). – P. 29–31.
6. Campos F.G., Perez R.O., Imperiale A.R. et. al. Surgical treatment of familial adenomatous polyposis: ileorectal anastomosis or restorative proctocolectomy? // Arq. Gastroenterol. – Vol. 46, N 4. – P. 294–299.
7. Choi R.S., Reiqler M., Pothoulakis C. et al. Studies of brush border enzymes, basement membrane components, and electrophysiology of tissue-engineered neointestine // J. Pediatr. Surg. – 1998. – Vol. 33. – P. 991–997.
8. Grikscheit T.C. et al. Tissue-engineered colon exhibits function in vivo // Surgery. – 2002. – Vol. 32. – P. 200–204.
9. Grikscheit T.C., Vacanti J.P. Tissue-engineered stomach from autologous and syngeneic tissue // J. Surg. Res. – 2002. – Vol. 107. – P. 277–288.
10. Groden J., Thliveris A., Samowitz W. et al. Identification and characterization of the familial adenomatous polyposis coli gene // Cell. – 1991. – Vol. 66. – P. 589–600.
11. Kaihara S. et al. Long-term follow-up of tissue-engineered intestine after anastomosis to native small bowel // Transplantation. – 2000. – Vol. 69. – P. 1927–1932.
12. Kasraoui M., Cohen R., Nicholls J. Results of surgical of the pouch after failed restorative proctocolectomy // Dis. Colon. Rectum. – 2004. – Vol. 47. – P. 869–675.
13. Kinzler K.W., Nilbert M.C., Su L.K. et al. Identification of FAP locus genes from chromosome 5q21 // Science. – 1991. – Vol. 253. – P. 661–665.
14. Miyoshi Y., Ando H., Nagase H. et al. Germline mutations of the APC gene in 53 familial adenomatous polyposis patients // Proc. Natl. Acad. Sci. USA. – 1992. – Vol. 89. – P. 4452–4456.
15. Nishisho I., Nakamura Y., Miyoshi Y. et al. Mutations of chromosome 5q21 genes in FAP and colorectal cancer patients // Science. – 1991. – Vol. 253. – P. 665–669.
16. Oded Zmora, Jonathan E. Efron, Juan J. Nogueras et al. Reoperative abdominal and perineal surgery in ileoanal pouch patients // Dis. Colon Rectum. – 2001. – Vol. 44, N 9. – P. 1310–1314.
17. Pars Y.R., Olschwang S., Desaint B. et al. Familial adenomatous: prevalence of adenomas in the ileal pouch after restorative proctocolectomy // Ann. Surg. – 2001. – Vol. 233. – P. 360–364.
18. Soravia C., Cohen Z. Familial adenomatous polyposis // Current therapy in colon and rectum surgery / Eds. Fazio V.N., Church J.M., Delaney C.P. – 2nd ed. – Philadelphia: Elsevier-Mosby, 2004. – P. 349–353.
19. Tavakkolizaden A. et al. Tissue-engineered neomucosa: morphology, enterocyte dynamics, and SGLT – 1 expression topography // Transplantation. – 2003. – Vol. 75. – P. 181–185.
20. Thompson-Fawcett M.W., Marcus V.A., Redston M. et al. Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous poliposis // Dis. Colon Rectum. – 2001. – Vol. 44, N 3. – P. 347–353.
21. Varesco L., Gismondi V., James R. et al. Identification of APC gene mutations in Italian adenomatous polyposis coli patients by PCR-SSCP analysis // Am. J. Hum. Genet. – 1993. – Vol. 52. – P. 280–285.
22. White R.L. Tumor suppressing pathways // Cell. – 1998. – Vol. 92. – P. 591–592.
Review
For citations:
Shelygin Yu.A., Kuzminov A.M., Vyshegorodtsev D.V., Kapuller L.L., Sukhikh G.T. Familial adenomatosis coli: surgical treatment with cellular transplantation. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012;22(6):53-58. (In Russ.)