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Comparable pouch retention rate between pediatric and adult patients after restorative proctocolectomy and ileal
Xian-rui Wu1, Saurabh Mukewar2, Jeffrey P Hammel1
1Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Insights
Pediatric inflammatory bowel disease (IBD) patients undergoing restorative proctocolectomy had more postoperative complications but similar long-term pouch retention rates compared to adults. This study highlights key differences in outcomes for IBD surgery across age groups.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Inflammatory Bowel Disease Research
Background:
- Inflammatory Bowel Disease (IBD) management often involves surgical interventions like restorative proctocolectomy with ileal pouch-anal anastomosis.
- Comparing outcomes between pediatric and adult IBD patients undergoing this procedure is crucial for tailored treatment strategies.
- Long-term pouch survival and complication rates can differ significantly based on patient age at the time of surgery.
Purpose of the Study:
- To compare the long-term surgical and functional outcomes of restorative proctocolectomy with ileal pouch-anal anastomosis in pediatric versus adult patients with IBD.
- To identify risk factors associated with pouch failure in both age groups.
- To evaluate the incidence of pouch-related complications and the need for specific medical interventions post-surgery.
Main Methods:
- A retrospective analysis of 104 pediatric (<18 years) and 1135 adult (≥18 years) IBD patients who underwent restorative proctocolectomy between 2002-2011 at a specialized Pouch Center.
- Comparison of demographic data, surgical indications, postoperative complications, and pouch failure rates between the pediatric and adult cohorts.
- Multivariate analysis was employed to determine independent risk factors for pouch failure.
Main Results:
- Pediatric patients had a shorter time from IBD diagnosis to colectomy and fewer had a history of smoking, extraintestinal manifestations, or dysplasia as an indication for surgery.
- Pediatric patients experienced higher rates of pouch procedure-related complications, postoperative hospitalizations, and use of anti-tumor necrosis factor (TNF) agents.
- Risk factors for pouch failure included preoperative and postoperative anti-TNF use, Crohn's disease of the pouch, procedure-related complications, and pouch-associated hospitalizations. Pediatric age was not a significant risk factor for pouch failure.
Conclusions:
- Patients who underwent restorative proctocolectomy at a pediatric age experienced a higher incidence of postoperative pouch complications compared to adults.
- Despite increased early complications, long-term pouch retention rates were comparable between pediatric and adult IBD patients.
- These findings underscore the importance of specialized care in managing IBD patients undergoing pouch surgery, with age not being a predictor of long-term pouch survival.
Background & Aims:
We compared long-term outcomes between adult and pediatric patients with inflammatory bowel disease (IBD) who underwent restorative proctocolectomy with ileal pouch-anal anastomosis.
Methods:
We performed a retrospective study that analyzed data from consecutive patients with ileal pouches who presented to the subspecialty Pouch Center at the Cleveland Clinic from 2002-2011. Pouch outcomes of 104 pediatric patients (having pouch surgery at age <18 years; 53 male) were compared with those of 1135 adults (having pouch surgery at an age 18 years or older; 632 male).
Results:
Pediatric patients had a shorter duration from time of IBD diagnosis to colectomy than adult patients. Fewer pediatric than adult patients had a history of smoking, concomitant extraintestinal manifestations, or dysplasia as the indication for colectomy. However, pediatric patients had higher rates of pouch procedure-related complications, postoperative pouch-associated hospitalization, and postoperative use of anti-tumor necrosis factor (TNF) agents. In multivariate analysis, risk factors for pouch failure included preoperative use of anti-TNF agents (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.05-3.13; P = .032), postoperative use of anti-TNF agents (HR, 2.07; 95% CI, 1.31-3.27; P = .002), Crohn's disease of the pouch (HR, 2.21; 95% CI, 1.28-3.82; P = .005), pouch procedure-related complications (HR, 2.68; 95% CI, 1.55-4.64; P < .001), and postoperative pouch-associated hospitalization (HR, 25.20; 95% CI, 14.44-43.97; P < .001). Being a pediatric patient was not significantly associated with pouch failure in univariate or multivariate analyses (HR, 0.6; 95% CI, 0.32-1.16; P = .13).
Conclusions:
On the basis of an analysis of patients with IBD who underwent restorative proctocolectomy and presented at a subspecialized Pouch Center, patients who had the surgery at a pediatric age tend to have a higher incidence of postoperative pouch complications than adults. However, long-term rates of pouch retention were comparable.
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