Restorative Proctocolectomy in Elderly IBD Patients: A Multicentre Comparative Study on Safety and Efficacy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Geriatric Medicine

Background:

• Outcomes of restorative proctocolectomy in elderly inflammatory bowel disease (IBD) patients are not well-documented.
• Surgical intervention in elderly IBD patients remains controversial.

Purpose of the Study:

• To evaluate the safety, efficacy, and long-term outcomes of ileal-pouch-anal anastomosis (IPAA) in elderly IBD patients.
• To compare outcomes between elderly and younger IBD patients undergoing IPAA.

Main Methods:

• A multicentre survey using the International Pouch Database (IPD) with 101 variables.
• Matched analysis comparing elderly patients (≥65 years) with younger controls (1:2 ratio) for open versus laparoscopic surgery.
• Statistical analysis included t-tests, chi-square, Fisher's exact tests, Kaplan-Meier, and log-rank tests.

Main Results:

• Elderly patients (n=77) had more comorbidities, longer disease duration, and more prior abdominal surgeries than controls (n=154).
• Postoperative complications and pouch failure rates were similar, but elderly patients experienced more severe complications (Clavien-Dindo IV-V) and longer hospital stays.
• Laparoscopic surgery was associated with shorter operative times and hospital stays compared to open surgery, with similar complication rates.

Conclusions:

• Restorative proctocolectomy is a viable option for selected elderly IBD patients, though increased risks of complications and prolonged hospitalization exist.
• Laparoscopic approaches may mitigate some of the challenges associated with surgery in this demographic.