P502. Feasibility and safety of totally laparoscopic restorative proctocolectomy for ulcerative colitis in the elderly. A prospective cohort study
F. Colombo1, G. Sampietro1, F. Alice1, S. Casiraghi1, A. Cassinotti1, S. Ardizzone1, F. Corsi1, D. Foschi1, 1“Luigi Sacco” University Hospital, Surgery, Gastroenterology and Oncology, Milano, Italy
Since its introduction in the early 1980s, very few data are available on the ileo-pouch-anal anastomosis (IPAA) performed in elderly patients. Laparoscopy seems to reduce morbidity in many surgical fields. Aim of the present study is to prospectively evaluate the feasibility and safety of laparoscopic IPAA for Ulcerative Colitis (UC) in patients over 65 years of age.
Starting from January 2007, all the consecutive, unselected patients with UC admitted in our Department and treated with a restorative proctocolectomy procedure were inserted in a prospective database. All surgical procedures, both proctocolectomy and abdominal colectomy followed by proctectomy and IPAA (staged surgery), were performed videolaparoscopically. Patients >65 years were compared to younger patients in terms of clinical characteristics, surgical procedure, and perioperative outcome. Analysis of data was performed using Student's t test, Fisher exact test, and Chi-square where appropriate.
From January 2007 to June 2012, 99 patients entered the study. 77 completed all the surgical steps up to the ileostomy closure. Of these, sixty-three (39 males) patients were <65 yrs and 14 (9 males) >65 yrs. The elderly group had a mean age of 69 yrs (compared to 45 yrs), duration of disease of 13 yrs (compared to 11 yrs; p = 0.04), higher ASA score (p = 0.002), dysplasia or cancer rate of 29% (compared to 18%, ns), emergency setting of 28% (compared to 26%, ns), conversion rate of 7% (compared to nil, ns), a one or two versus three steps procedure of 71% (compared to 52%, ns), stapled IPAA of 93% (compared to 89%, ns), overall major and minor complication rate of 28% and 7% (compared to 19% and 28%, ns), overall readmission and reoperation rate of 7% and 14% (compared to 28% and 17%, ns). No significant differences were found in preoperative medication with steroids, immunomodulators (thiopurine, cyclosporine and anti-TNF) or combined therapy. Operative data were similar for both groups.
Totally laparoscopic proctocolectomy with IPAA for UC in elderly patients over 65 yrs of age is a safe and effective procedure. Minimally invasive approach seems to maintain its advantages in older patients, reducing the surgical impact in patients with high comorbid conditions. Age and comorbidities do not seem to be a contraindication to totally laparoscopic IPAA surgery.