LONG-TERM CAUSES OF DEATH FOLLOWING ILEAL POUCH-ANAL ANASTOMOSIS

PURPOSE: The aim of this study was to identify the overall long-term c auses of death in a large series of patients who were undergoing proct ocolectomy with ileal pouch-anal anastomosis (IPAA). METHODS: Records of patients who underwent proctocolectomy with IPAA at the Mayo Clinic affiliated hospitals between January 1981 and October 1994 were revie wed to determine overall mortality, cause, and timing of death. RESULT S: A total of 1,603 patients underwent proctocolectomy with IPAA recon struction (1,407 for chronic ulcerative colitis (CUC), 187 for familia l polyposis (FAP), and 9 for other diagnoses). Thirty-two patients hav e died, with an overall mortality rate of 2 percent. Mean age at time of death was 40 (23-60) years. There was no significant difference in overall mortality between patients with CUC and patients with FAP. Thr ee deaths occurred postoperatively (0.2 percent) because of pulmonary embolism, perforated gastric ulcer, and subarachnoid hemorrhage. Late deaths occurred in 29 patients (1.8 percent), 10 months to 10.4 rears after the operation. The most common cause of late death was cancer, i ncluding colon and rectal carcinoma (10 patients), hematologic maligna ncies (4 patients), cholangiocarcinoma (3 patients), and germ-cell car cinema (1 patient). Four patients died from unrelated sepsis, two die d following myocardial infarction, two patients died from complication s of subsequent orthopedic surgery, and one patient died of cirrhosis. Two additional patients committed suicide. No late deaths were direct ly attributable to the IPAA procedure. CONCLUSIONS: Proctocolectomy wi th IPAA is a safe procedure. Operative mortality is low, and late deat hs are related to carcinogenic and extracolonic manifestations of unde rlying or unrelated coexisting diseases and events.