Restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication?. Issue 9 (18th April 2022)

• Record Type: Journal Article
• Authors: Duraes, Leonardo C.; Liang, Jennifer; Steele, Scott R.; Cengiz, Bora; Delaney, Conor P.; Holubar, Stefan D.; Gorgun, Emre
• Is Part Of: ANZ journal of surgery. Volume 92:Issue 9(2022)
• Page Start: 2180
• Page End: 2184
• Publication Date: 2022-04-18
• Subjects: elderly -- inflammatory bowel disease -- IPAA -- ulcerative colitis; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.17728
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Aim: We aimed to determine pouch function and retention rate for restorative proctocolectomy with ileal pouch‐anal anastomosis (IPAA) for ulcerative colitis (UC) in elderly patients. Methods: We identified patients over 50 years old subjected to IPAA for confirmed pathological UC from 1980 until 2016. Patients were grouped according to age: 50–59, 60–69 and 70+ years. Short and long‐term outcomes and quality of life (QOL) were compared among the groups. Results: Six hundred and one patients were identified (399 (66.4%) between 50–59 181 (30.1%) between 60–69, and 21 (3.5%) over 70 years of age). More males were in the 70+ arm, and more two‐stage procedures were performed in this group. Wound infection increased with age ( P = 0.023). There was a trend of more fistula and pouchitis in the 70+ patients ( P = 0.052 and P = 0.055, respectively). Pouch failure rate increased with age, and it was statistically significant in the 70+ cohort ( P = 0.015). Multivariate stepwise logistic regression showed that pelvic sepsis (HR 4.8 (95% CI 1.5–15.4), P = 0.009), fistula (HR 6.0 (95% CI 1.7–21.5), and mucosectomy with handsewn anastomosis (HR 4.5 (95% CI 1.4–14.7)), were independently associated with pouch failure. No difference was observed in the QOL among the groups, but pouch function was better for patients younger than 60 years. Conclusion: In elderly patients with UC, IPAA may be offered with reasonable functional outcomes, and ileal pouch retention rates, as an alternative to the permanent stoma. Stapled anastomosis increases the chance of pouch retention and should be recommended as long as the distal rectum does not carry dysplasia. Abstract : Ileal pouch‐anal anastomosis (IPAA) can be safely performed in patients with ulcerative colitis (UC) over 50 years old, with good outcomes and quality of life (QOL). However, pouch retention rates decrease for patients over 70 years. Stapled anastomosis increases the chance of pouch retention and should be recommended as long as the distal rectum does not carry dysplasia.