Comparison of the outcomes of ileal pouch-anal anastomosis and ileorectal anastomosis for patients with familial adenomatous polyposis: A systematic review and meta-analysis.

Authors

Phuong Minh Tang, Bui Thien Nghiep Vo, Tung-Cheng Chang, El-Wui Loh, Ka-Wai Tam

Published in

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. Pages 102512. Aug 13, 2026. Epub Aug 13, 2026.

Abstract

Familial adenomatous polyposis (FAP) is an inherited colorectal cancer syndrome for which ileorectal anastomosis (IRA) preserves the rectum but ileal pouch-anal anastomosis (IPAA) removes it. These procedures may influence the risk of desmoid tumors and involve trade-offs in oncologic protection and bowel function. This study compared the oncologic, desmoid, functional, and postoperative outcomes of IRA and IPAA in FAP.
PubMed, Embase, Scopus, and the Cochrane Library were searched for relevant studies. Primary outcomes were rectal or pouch-anal cancer and desmoid tumors. Risk of bias was assessed using the ROBINS-I tool, and certainty of evidence was assessed using the GRADE framework. Random-effects meta-analyses were conducted using pooled risk ratios (RRs), mean differences (MDs), and hazard ratios.
Thirty-four studies involving 4,700 patients were included. Compared with IRA, IPAA was associated with lower risks of postoperative rectal and pouch-anal cancer (RR: 0.22, 95% CI: 0.09-0.54) but with a higher risk of desmoid tumors (RR: 1.58, 95% CI: 1.13-2.19). IPAA was associated with higher 24-hour incontinence (RR: 1.90, 95% CI: 1.24-2.92) and 24-hour stool frequency (MD: 1.89 stools/day, 95% CI: 1.29-2.49). Anastomotic stricture was more frequent after IPAA (RR: 2.91, 95% CI: 1.46-5.78), but major complications did not differ substantially between the procedures.
IPAA is associated with greater long-term oncologic protection but worse bowel function and a higher desmoid tumor risk compared with IRA. These findings support individualized procedure selection based on surveillance feasibility to balance functional trade-offs, perioperative risk, and durability.

PMID:
42594997
Bibliographic data and abstract were imported from PubMed on 14 Aug 2026.

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