Cargando…

Restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication?

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 201...

Descripción completa

Detalles Bibliográficos
Autores principales: Duraes, Leonardo C., Liang, Jennifer, Steele, Scott R., Cengiz, Bora, Delaney, Conor P., Holubar, Stefan D., Gorgun, Emre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons Australia, Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542127/
https://www.ncbi.nlm.nih.gov/pubmed/35434821
http://dx.doi.org/10.1111/ans.17728
_version_ 1784804080155099136
author Duraes, Leonardo C.
Liang, Jennifer
Steele, Scott R.
Cengiz, Bora
Delaney, Conor P.
Holubar, Stefan D.
Gorgun, Emre
author_facet Duraes, Leonardo C.
Liang, Jennifer
Steele, Scott R.
Cengiz, Bora
Delaney, Conor P.
Holubar, Stefan D.
Gorgun, Emre
author_sort Duraes, Leonardo C.
collection PubMed
description 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.
format Online
Article
Text
id pubmed-9542127
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley & Sons Australia, Ltd
record_format MEDLINE/PubMed
spelling pubmed-95421272022-10-14 Restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication? Duraes, Leonardo C. Liang, Jennifer Steele, Scott R. Cengiz, Bora Delaney, Conor P. Holubar, Stefan D. Gorgun, Emre ANZ J Surg Colorectal Surgery 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. John Wiley & Sons Australia, Ltd 2022-04-18 2022-09 /pmc/articles/PMC9542127/ /pubmed/35434821 http://dx.doi.org/10.1111/ans.17728 Text en © 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Colorectal Surgery
Duraes, Leonardo C.
Liang, Jennifer
Steele, Scott R.
Cengiz, Bora
Delaney, Conor P.
Holubar, Stefan D.
Gorgun, Emre
Restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication?
title Restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication?
title_full Restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication?
title_fullStr Restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication?
title_full_unstemmed Restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication?
title_short Restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication?
title_sort restorative proctocolectomy with ileal pouch‐anal anastomosis in elderly patients – is advanced age a contraindication?
topic Colorectal Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542127/
https://www.ncbi.nlm.nih.gov/pubmed/35434821
http://dx.doi.org/10.1111/ans.17728
work_keys_str_mv AT duraesleonardoc restorativeproctocolectomywithilealpouchanalanastomosisinelderlypatientsisadvancedageacontraindication
AT liangjennifer restorativeproctocolectomywithilealpouchanalanastomosisinelderlypatientsisadvancedageacontraindication
AT steelescottr restorativeproctocolectomywithilealpouchanalanastomosisinelderlypatientsisadvancedageacontraindication
AT cengizbora restorativeproctocolectomywithilealpouchanalanastomosisinelderlypatientsisadvancedageacontraindication
AT delaneyconorp restorativeproctocolectomywithilealpouchanalanastomosisinelderlypatientsisadvancedageacontraindication
AT holubarstefand restorativeproctocolectomywithilealpouchanalanastomosisinelderlypatientsisadvancedageacontraindication
AT gorgunemre restorativeproctocolectomywithilealpouchanalanastomosisinelderlypatientsisadvancedageacontraindication