Restorative proctocolectomy with ileal pouch-anal anastomosis is safe and effective in selected very elderly patients suffering from ulcerative colitis

Abstract

Restorative proctocolectomy (RP) with ileal pouch-anal anastomosis is the mainstay treatment for intractable or refractory ulcerative colitis (UC). Safety and effectiveness of RP in elderly patients are debated. Our aim was to compare surgical outcomes and function of patients undergoing RP over 80-year-of-age with those of younger controls.We retrospectively gathered data of patients receiving RP for UC aged >80 years between January 1990 and December 2012. A control group of younger patients was established for comparison (1:3 ratio). Functional outcomes and satisfaction with surgery 6 and 12 months after ileostomy closure were collected.Ten patients >80-year-old were included (median age 87.5, range 84–90 years). All patients had at least one comorbidity (mean 2.1 ± 1) and were receiving medications for concomitant diseases. Half of them received a 3-stage procedure. Neither death nor major perioperative complications were observed. One patient (10%) required readmission for dehydration 2 weeks after RP with loop-ileostomy. Thirty younger patients (median age 34.3, range 25–52 years) served as controls. All patients had their ileostomy closed within 3 months from RP. At 6 month follow-up, elderly patients had more nocturnal seepage, antidiarrhoeals intake, and a trend toward more frequent day-time incontinence. At 12-month follow-up differences were less apparent. Only nocturnal seepage was higher in elderly. All patients retained their pouch and would have undergone surgery again. RP is feasible in selected advanced age patients, and functional results are comparable to younger patients.