P355. Safety and efficacy of restorative proctocolectomy in the elderly. A European, prospective, multicenter, S-ECCO study
F. Colombo1, A. de Buck2, S. Sahami3, A. D'Hoore2, W. Bemelman3, Y. Panis4, G. Sampietro5, 1Luigi Sacco University Hosptal, Department of Surgery, Milano, Italy, 2University Hospitals Gasthuisberg, Department of Abdominal Surgery, Leuven, Belgium, 3Academic Medical Center, Surgery, Amsterdam, Netherlands, 4Hôpital Beaujon, Pole des Maladies de L'Appareil Digestif, Clichy, France, 5Luigi Sacco University Hospital. IBD Surgical Unit, Department of Surgery, Milano, Italy
Despite the expanding incidence of restorative proctocolectomy and ileal-pouch-anal anastomosis (IPAA) in children and adults, and the advent of laparoscopic procedures, very few data are available in elderly patients. Aim of this survey was to evaluate safety and efficacy of IPAA in patients over 65 years of age in a referral multicenter survey.
Patients from prospective databases on pouch surgery from Milano, Leuven, Amsterdam and Clichy have been collected. Preoperative characteristics, including medical therapy, perioperative complications and postoperative results have been analyzed. Statistical analysis have been performed using chi-square and Student-t tests where appropriate. Time-to-event estimates were performed using Kaplan–Meier function (Statistica, StatSoft Inc.).
Fifty-nine patients were identified in the databases. Males were 70%, smokers 10%, 6.7% had a family history of IBD, and 18.6% presented extra intestinal manifestations. ASA score was 1 in 6.7%, 2 in 62.7%, and 3 in 30.6%. Indication for surgery were Ulcerative Colitis in 74.5%, Indeterminate Colitis or Crohn's disease in 8.5%, Familial Polyposis in 3.4%, and dysplasia or cancer in 13.6%. 25% of patients were receiving steroids, 17% immunomodulators, and 6.7% biological, but 34% of these patients received a combined therapy. A laparoscopic approach was used in 70% of patients, with a conversion rate of 12%. All pouches ware stapled J-pouches, and a stapled IPAA was performed in 83%. Readmission rate was 6.7%, reoperation rate was 8.5%. mortality was 1.6%. Pelvic sepsis due to leakage complicated 10% of the patients. Pouchitis and failure rate were 10% and 5% at 10 years respectively. None of the prognostic factors analyzed was related to surgical complications.
Total proctocolectomy with ileal-pouch-anal anastomosis is a safe and effective procedure, with a standardized approach in Europe. Elderly patients, despite elevated comorbidities, are suitable for this procedure. Careful selection of patients and laparoscopic approach can guarantee a good perioperative safety, acceptable functional results and low long term failure.