RESTORATIVE PROCTOCOLECTOMY IN PATIENTS OLDER THAN 50 YEARS

PURPOSE: This study was undertaken to compare functional results, comp lications, preoperative durations of disease, and rates of dysplasia a nd neoplasia between older and younger chronic ulcerative colitis pati ents undergoing restorative proctocolectomy (RPC) with mucosectomy. ME THODS: A total of 392 patients with a preoperative diagnosis of chroni c ulcerative colitis underwent elective RPC with mucosection and hands ewn iteoanal anastomosis. Pathologic reports were reviewed, with speci fic reference to findings of dysplasia or cancer. Functional results c oncerning the number of bowel movements per 24 hour period and the inc idence of fecal soilage were obtained by direct or telephone patient i nterview. FINDINGS: Group I consisted of 326 patients aged 5 to 49 (me an, 30.9) years and 160 women. Group II comprised 66 patients aged 50 to 74 (mean, 56.9) years and 29 women. Duration of disease was signifi cantly longer in the older group (6.2 vs. 15.6 years; P < 0.001). The older group had significantly higher fates of dysplasia (29/326 vs. 19 /66; P < 0.0001) and malignancy (14/326 vs. 9/66; P = 0.003). Rates of complication, hospital days following RPC, and total hospital days fo r all causes were comparable between groups. Perfect daytime continenc e was observed in 81.6 percent of Group I and 80 percent of Group II p atients (213/261 us. 40/50; P = 0.79). Perfect continence during sleep was observed in 65.1 percent of Group I and 62 percent of Group II pa tients (170/261 vs. 31/50; P = 0.67). Mean number of bowel movements p er 24 hour period for Group I was 6.3 +/- 0.2 and for Group II was 7.4 +/- 0.5. Mean difference, one movement per 24 hours, was not signific ant (35 percent confidence interval, -0.02 to 2.1; t = 1.35, P = 0.055 ). CONCLUSIONS: We conclude that patients older than 50 years are suit able candidates for RPC with mucosectomy. Functional results and compl ication rates are similar to those observed among younger patients. Pa tients older than 50 years have a significantly higher rate of concurr ent dysplasia and malignant degeneration than younger patients, most p robably because of a longer duration of disease. RPC with mucosal exci sion potentially lowers this risk by elimination of all colorectal muc osa.