Familial adenomatous polyposis (FAP) caused by APC gene mutations on chromosome 5q21 carries near 100% risk of colorectal cancer. The CLASSIC prophylactic operation recommended when polyp burden is heaviest in the sigmoid and rectum is:
- A Total colectomy with ileorectal anastomosis
- B Restorative proctocolectomy with ileal pouch-anal anastomosis ✓
- C Proctocolectomy with end ileostomy
- D Subtotal colectomy with cecorectal anastomosis
Correct answer: B. Restorative proctocolectomy with ileal pouch-anal anastomosis
Explanation
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard prophylactic operation for FAP, removing the entire colorectal mucosa at risk while preserving continence. Ileorectal anastomosis (IRA) is an alternative when rectal polyp burden is low and patient desires to avoid pouch, but requires lifelong rectal surveillance. When the rectum has dense polyposis, IRA is inappropriate due to cancer risk.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.