title: Restorative Proctocolectomy in Elderly IBD Patients: A Multicentre Comparative Study on Safety and Efficacy.
abstract: OBJECTIVE
  Restorative proctocolectomy in elderly inflammatory bowel disease [ IBD] patients is controversial and limited data are available on the outcomes of surgery. The aim of this study was to evaluate the safety, efficacy, and long-term results of ileal-pouch-anal anastomosis in elderly patients, in a multicentre survey from European referral centres.
  
  
  METHODS
  The International Pouch Database [IPD] combined 101 variables. Patients aged ≥ 65 years were matched on the basis of open versus laparoscopic surgery with a control group of consecutive younger unselected patients with a ratio of 1:2. Statistical analysis was performed using two-tailed t test, chi square and Fisher's exact tests, Kaplan-Meier function, and log-rank tests where appropriate.
  
  
  RESULTS
  In the IPD, 77 patients aged ≥ 65 years [Group A] and 154 control patients [Group B] were identified. Elderly patients had more comorbidities [p = 0.0001], longer disease duration [p = 0.001], less extensive disease [p = 0.006], more previous abdominal operations [p = 0.0006], surgery for cancer or dysplasia more frequently [p = 0.0001], fewer single-stage procedures [p = 0.03], more diversions after ileal pouch-anal anastomosis [IPAA] [p = 0.05], and a higher laparoscopic conversion rate [p = 0.04]. Postoperative complications and pouch failure were similar between the groups, but Group A had more Clavien-Dindo IV-V complications [p = 0.04], and longer length of stay [p = 0.007]. Laparoscopy was associated with a shorter duration of surgery [p = 0.0001], and length of stay [p = 0.0001], and the same complication rate as open surgery.
  
  
  CONCLUSIONS
  Restorative proctocolectomy can be performed in selected elderly patients, but there is a higher risk of postoperative complications and longer length of stay in this group. Laparoscopy is associated with shorter operating time and length of stay.
authors.affiliation: Luigi Sacco University Hospital, Department of Surgery, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Colombo
authors.affiliation: Academisch Medisch Centrum, Department of Colorectal Surgery, Amsterdam, The Netherlands.
authors.forename: Saloomeh
authors.initials: S
authors.lastname: Sahami
authors.affiliation: Universitaire Ziekenhuizen, Department of Abdominal Surgery, Leuven, Belgium.
authors.forename: Antony
authors.initials: A
authors.lastname: de Buck Van Overstraeten
authors.affiliation: Sourasky Medical Centre, Division of Surgery Colorectal Unit, Tel Aviv, Israel.
authors.forename: Hagit
authors.initials: H
authors.lastname: Tulchinsky
authors.affiliation: Hopital Beaujon, Pole des Maladies de l'Appareil Digestif, Clichy, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Mege
authors.affiliation: Sourasky Medical Centre, Department of Gastroenterology and Liver Diseases, Tel Aviv, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Dotan
authors.affiliation: Luigi Sacco University Hospital, Department of Surgery, Milan, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Foschi
authors.affiliation: St. Mark's Hospital, Department of Surgery, Harrow, UK.
authors.forename: Cosimo Alex
authors.initials: CA
authors.lastname: Leo
authors.affiliation: St. Mark's Hospital, Department of Surgery, Harrow, UK.
authors.forename: Janindra
authors.initials: J
authors.lastname: Warusavitarne
authors.affiliation: Universitaire Ziekenhuizen, Department of Abdominal Surgery, Leuven, Belgium.
authors.forename: André
authors.initials: A
authors.lastname: D'Hoore
authors.affiliation: Hopital Beaujon, Pole des Maladies de l'Appareil Digestif, Clichy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
authors.affiliation: Academisch Medisch Centrum, Department of Colorectal Surgery, Amsterdam, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Bemelman
authors.affiliation: Luigi Sacco University Hospital, Department of Surgery - IBD Surgical Unit, Milan, Italy.
authors.forename: Gianluca M
authors.initials: GM
authors.lastname: Sampietro
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
keywords: Crohn’s disease; IPAA; complications; elderly; laparoscopy; pouch; proctocolectomy; surgery; ulcerative colitis