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Surgical management typically involves restorative proctocolectomy with an ileal pouch anal anastomosis or colectomy with ileorectal anastomosis. Complete removal of the large intestine and rectum with a permanent stoma may also be required in selected cases. This narrative review highlights decision-making in FAP regarding the timing, extent, and modality of large bowel surgery. Key considerations include the extent of polyps, cancer risk in the remaining rectum, and associated extra-colonic manifestations like desmoid disease. The timing of surgery and the extent of bowel removal are critical factors requiring a personalized approach that considers patient preferences and clinical factors. Regardless of the chosen strategy, continued surveillance is essential to monitor disease progression.<\/jats:p>","DOI":"10.1007\/s10689-025-00492-6","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T08:32:49Z","timestamp":1757061169000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Surgical management of the colorectum in FAP: tailored approaches for optimal outcomes"],"prefix":"10.1007","volume":"24","author":[{"given":"A.","family":"Sinha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9333-0399","authenticated-orcid":false,"given":"J. 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DL was a consultant for Medtronic and received research support to institution from Freenome. No other conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"69"}}