title: Clinical outcomes of perineal proctectomy among patients of advanced age.
abstract: BACKGROUND
  Rectal prolapse occurs primarily in older patients who often have significant comorbidities. With the aging population, increasing numbers of elderly patients are presenting with rectal prolapse. The perineal approach is preferred for these patients because it involves less perioperative risk than an abdominal procedure, but the outcomes of this procedure in elderly patients are unknown.
  
  
  OBJECTIVE
  The aim of this study was to examine whether clinical outcomes after perineal proctectomy are similar among elderly patients versus patients of younger age.
  
  
  METHODS
  This study was a retrospective review.
  
  
  METHODS
  This study was conducted in mixed academic and private practice; the operations were performed at 16 hospitals.
  
  
  METHODS
  Patients who had perineal proctectomy for rectal prolapse from 1994 to 2012 were grouped according to age: <70 (group A), 70 to 79 (group B), 80 to 89 (group C), and ≥90 years (group D).
  
  
  METHODS
  Perineal proctectomy with or without concurrent levatorplasty was performed.
  
  
  METHODS
  The primary outcomes measured were postoperative complications, recurrence, and survival after perineal proctectomy.
  
  
  RESULTS
  Four hundred patients underwent 518 perineal proctectomies: group A, N = 113; group B, N = 113; group C, N = 208; and group D, N = 84. The immediate and late complication rates were 5.6% and 3.5% and did not vary by age. Recurrence was 22.6% and was significantly different between groups, with the lowest recurrence in group D, 14.3% (p = 0.007). Reoperation after recurrence was less likely in group D. The main type of reoperation was perineal proctectomy (41.5%), but, for group D, recurrence was usually managed nonoperatively (58.3%). Median survival after operation was more than 4 years in the advanced age group.
  
  
  CONCLUSIONS
  Retrospective data, which did not allow analysis of patients with rectal prolapse who did not undergo surgery, were used in this study.
  
  
  CONCLUSIONS
  When selected appropriately, patients 90 years of age or older have outcomes similar to younger patients; therefore, age alone should not be a contraindication to surgery. In addition, elderly patients have a median survival of more than 4 years after surgery, so the operative risk can be worth the benefit accrued.
authors.affiliation: 1University of Bangkok Metropolis, Bangkok, Thailand 2Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota 3Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Rangsima
authors.initials: R
authors.lastname: Tiengtianthum
authors.forename: Christine C
authors.initials: CC
authors.lastname: Jensen
authors.forename: Stanley M
authors.initials: SM
authors.lastname: Goldberg
authors.forename: Anders
authors.initials: A
authors.lastname: Mellgren
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D012005:Rectal Prolapse / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult