54 A new study suggests that minimally invasive surgery could significantly reduce the risk of developing aggressive tumours in patients with a rare inherited cancer syndrome. The findings were published in the journal BJS Open. Researchers from the National Cancer Institute in Milan analysed data from over 200 individuals with familial adenomatous polyposis, a genetic condition that causes hundreds of polyps in the colon and almost inevitably leads to colorectal cancer without preventive surgery. The focus of the research was the development of desmoid tumours, non-cancerous growths that can cause severe complications in this group of patients, particularly following abdominal surgery. Desmoid tumours are a well-recognised risk after surgery in familial adenomatous polyposis, often forming in the abdomen where they can cause pain, bowel obstruction and other complications. In the current study, 10.4 per cent of patients developed such tumours after undergoing colorectal surgery, confirming their prominence as a post-operative risk. The study found that the type of surgery performed had a major impact on the likelihood of tumour development. Patients who had undergone a rectal-sparing total colectomy using keyhole surgery were less likely to develop desmoid tumours than those who had a more extensive procedure known as a proctocolectomy. Open surgery also appeared to carry a higher risk than laparoscopic approaches. Interestingly, the presence of cancer at the time of surgery was linked to a lower risk of developing desmoid tumours, while those with a family history of the tumours were more likely to develop them. These associations remained consistent even when other variables were taken into account. While previous research has hinted at similar trends, this study strengthens the case for using less invasive surgical techniques when treating patients with familial adenomatous polyposis. The findings also challenge concerns that early surgery may provoke tumour formation. In fact, earlier intervention did not appear to increase the risk. Despite the protective benefits of minimally invasive surgery, the researchers highlighted the absence of a dedicated surveillance strategy for desmoid tumours in these patients. Most cases in the study were diagnosed only after symptoms developed, raising concerns about delayed detection and missed opportunities for early intervention. The authors of the study call for a structured follow-up plan to monitor patients after surgery, potentially involving regular imaging to detect tumours before they begin to cause problems. With a better understanding of risk factors and the impact of surgical choices, clinicians may be able to tailor treatment strategies that both prevent colorectal cancer and minimise the risk of serious complications like desmoid tumours. Although the findings provide valuable insights, the authors acknowledge limitations in their study design, including its retrospective nature and the relatively small number of tumour cases. More comprehensive research, including prospective trials, will be needed to confirm the protective effect of minimally invasive surgery and develop optimal surveillance protocols.