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.