Comparison of Quality of Life (Qol) Between Ileal J Pouch-Anal Anastomosis and Permanent Ileostomy After Proctocolectomy for Ulcerative Colitis in Elderly Patients
Munenori Nagao*1, Kouhei Fukushima1, Chikashi Shibata1, Koh Miura1, Hitoshi Ogawa1, Yuji Funayama2, Michiaki Unno1, Iwao Sasaki1
1surgery, Tohoku university, Sendai, Japan; 2surgery, Tohoku-Rosai hospital, Sendai, Japan
Aim: The aim was to study if different operative procedures affect postoperative QOL in elderly patients (>=50 years) with ulcerative colitis (UC).
Methods: Questionnaire to score QOL was mailed to each patient, and IBD-Q of Japanese edition was used for questionnaire. IBD-Q consists of questions asking bowel symptoms, systemic symptoms, emotional functions, and social functions. Patients were classified into 2 groups; young group (N=18, 20-29 years old) as control and old group (N=41, 50 years or older). Old group was further classified into 2 groups by operative procedures; 19 patients undergoing proctocolectomy with ileal J pouch-anal (canal) anastomosis (IPA(C)A group) and 22 patients undergoing proctocolectomy with permanent ileostomy (stoma group). All patients in young group underwent proctocolectomy with IPAA.
Results: There was no difference in the median age between IPA(C)A (56.5 years: range 50-75) and stoma (64.2 years: range 52-75) groups. Median total QOL scores did not differ between IPA(C)A (160) and stoma (166) group. The same was true for bowel function scores (55 in IPA(C)A group, 52 in stoma group), systemic function scores (24 in IPA(C)A group, 21.5 in stoma group), emotional function scores (66 in IPA(C)A group, 68 in stoma group), and social function scores (23 in IPA(C)A group, 21.5 in stoma group). Median total QOL scores in old group (166) were lower than those in young group (180, p<0.05). Bowel symptom scores and social function scores in old group (54 for bowel symptom scores and 23 for social function scores) were also low compared to young group (61 for bowel symptom scores and 27 for social function scores, p<0.05). Systemic function scores and emotional function scores were not different between old and young groups.
Conclusions: Proctocolectomy with permanent ileosotomy was considered an acceptable procedure for elderly patients with UC, because not only total QOL scores but also each functional score did not differ between old patients undergoing IPA(C)A and permanent ileostomy. Total QOL scores as well as bowel symptoms and social functions were impaired in old patients compared to young patients.
