Surgery for MutYH-associated polyposis (systematic review, meta-analysis)

Abstract

BACKGROUND: to date, there are no clear guidelines for MutYH-associated polyposis (MAP) surgery.AIM: to study the world literature on MutYH-associated polyposis surgery using a meta-analysis.MATERIALS AND METHODS: the systematic review was carried out in accordance with the practice and guidelines of PRISMA. The meta-analysis included the results of 14 case studies, 4 cohort studies, as well as own data on patients with MAP. A total of 474 patients with MAP were analyzed.RESULTS: when analyzing the number of colorectal polyps, the total occurrence value (95% CI: 0-14) of less than 10 polyps was 10%, in 52% cases (95% CI: 0-100) from 10 to 100 polyps were detected, in the remaining cases there were more than 100 polyps. Colorectal cancer was diagnosed in 56% of patients (95% CI: 45–66) of patients, while tumors with the T1-T3 were found in 38% of cases, tumors with the T4 were found in 7% of cases, lesions of the regional lymph nodes N + were found in 8%. The synchronous tumors were detected in 12%, and metachronous — in 5%. In 87%, some parts of the large intestine were preserved, in 38% [95% CI: 0-100] — colectomy with ileorectal anastomosis, in 27% [95% CI: 23-31] — colorectal resection, in 22% [95% CI: 16-27] — polypectomy), in other cases total removal of all parts of the large bowel was performed.CONCLUSION: patients with MAP who have been diagnosed with less than 100 colorectal polyps may undergo endoscopic polypectomy, if technically possible. Despite the risk of developing CRC, which in most cases has a nonaggressive course, the clinical course of MutYH-associated polyposis is relatively favorable. For this category of patients, it is possible to limit colorectal resection with annual endoscopic control and removal of detectable polyps in the remaining parts of the large bowel