Restorative Proctocolectomy in Elderly IBD Patients: A Multicentre Comparative Study on Safety and Efficacy

Francesco Colombo, Saloomeh Sahami, Antony de Buck Van Overstraeten, Hagit Tulchinsky, Diane Mege, Iris Dotan, Diego Foschi, Cosimo Alex Leo, Janindra Warusavitarne, André D'Hoore, Yves Panis, Willem Bemelman, Gianluca M. Sampietro

Research output: Contribution to journalArticlepeer-review


Background and Aims: 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.

Original languageEnglish
Pages (from-to)671-679
Number of pages9
JournalJournal of Crohn's and Colitis
Issue number6
StatePublished - 1 Jun 2017
Externally publishedYes


  • Crohn’s disease
  • IPAA
  • complications
  • elderly
  • laparoscopy
  • pouch
  • proctocolectomy
  • surgery
  • ulcerative colitis


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