101 A new retrospective study has provided critical insights into the risk factors and protective measures for desmoid tumours in individuals with familial adenomatous polyposis (FAP). Conducted by researchers in Milan, the study highlights how surgical approaches and family history influence the likelihood of developing these rare but significant tumours. The findings were published in the journal BJS Open. FAP is a hereditary condition characterised by numerous colorectal polyps, posing a high risk of colorectal cancer. Preventive surgeries, such as colectomies, are often performed to mitigate this risk. However, these procedures have inadvertently increased the attention given to desmoid tumours, a type of benign growth occurring more frequently in those with FAP compared to the general population. The research, spanning 23 years, reviewed the medical records of 202 patients with confirmed FAP who underwent colorectal surgery. Of these, 21 developed desmoid tumours, accounting for 10.4% of the cohort. The study identified several factors influencing the development of these tumours, including the surgical approach, type of procedure, and family history. Patients undergoing minimally invasive surgeries, such as laparoscopic rectal-sparing colectomies, were found to have a significantly lower risk of developing desmoid tumours. In contrast, open surgeries and more extensive procedures, like proctocolectomies, were associated with an elevated risk. Family history also played a substantial role, with those having relatives affected by desmoid tumours being nearly three times more likely to develop them. Histology at the time of surgery emerged as another key factor. Patients with a non-cancerous histological profile during their procedures were less likely to experience desmoid tumours. Notably, the study found no significant correlation between the age at surgery and tumour development, suggesting that early surgical intervention does not exacerbate the risk. While desmoid tumours are benign, they can cause severe complications, including intestinal obstruction and ischaemia, necessitating careful management. Current treatment options range from active surveillance to medical therapies, depending on the tumour’s size and symptoms. But the researchers advocate for a dedicated surveillance programme tailored specifically for FAP patients. Regular monitoring could facilitate early detection, improving outcomes and preserving patients’ quality of life. Despite its findings, the study acknowledges limitations, including its retrospective design and relatively small sample size. The authors suggest further research to refine surgical techniques and establish robust surveillance protocols for FAP-associated desmoid tumours. The results underscore the importance of surgical decision-making and comprehensive family history assessments in managing FAP. By adopting minimally invasive approaches and enhancing post-surgical monitoring, healthcare providers can mitigate the risks associated with desmoid tumours, ensuring better long-term care for patients.