Abstracts
1999 Digestive Disease Week

# 2205 RECTAL EXCISION AND PRESERVATION OF CONTINENCE IN THE ELDERLY.
Gaudenz Curti, Christian Hamel, Kantonsspital Luzern, Luzem Switzerland; Felix Harder, Univ Dept of Surg, Basel Switzerland; Markus Von Flue, Kantonsspital Luzern, Luzern Switzerland

Introduction: Preservation of continence after total mesorectal excision (TME) in the elderly is still a controversial item. Dysfunction of the pelvic floor and weakness of the anal sphincter following coloanal reconstruction (CAA) may lead to impaired continence. This study compares morbidity, mortality and anorectal function of patients over 70 vs. a younger group following CAA. Method: To prove the good results of TME and CAA in the elderly we compared prospectively collected data of 27 elderly patients (70-89a, Group A) vs. a younger cohort of 29 patients (41-68a, Group B) regarding morbidity, mortality, continence and patients satisfaction following TME and CAA. Continence was evaluated using the Kirwan-Parks' score. The evaluation of continence and satisfaction was done using a questionnaire. Comparing the different methods of reconstruction was not an aim of the study. Results: The median follow-up after closure of the stoma is 15.2 (A) vs. 20.4 months (B), respectively. Mortality after 30 days was 3.7% (1 myocardial infarction) vs. 0%. Late mortality was 27% vs. 20%. Reconstruction was performed using an ileocecal pouch (ICP) in 17, a coloanal J-pouch (CJP) in 2 and a straight CAA in 8 cases, respectively (A) vs. 26 ICP and 9 CJP (B). An ostomy was performed in 66% of all patients and closed after a median interval of 7.9 weeks. Postoperative morbidity was 11% (2x leak, 1 presacral abscess) (A) vs. 6% (1compartment-syndrome, 1abscess). Late morbidity was 7.4% (2 strictures) vs. 5.7%. According to the Kirwan-Parks' score 84% vs. 96% were completely continent. Soiling was absent in 68% vs. 68%. Satisfaction was good to excellent in 88% vs. 83%, medium in 8% vs. 13% and bad in 4% vs. 3% (A vs. B), respectively. Conclusion: TME and CAA to preserve continence in deeply situated rectal cancer are usually well tolerated even in the elderly. Employing adequate surgical technique the rate of surgical complications is low and not significantly elevated compared to the younger cohort. Postoperative mortality is not significantly elevated in the elderly. The relatively high late mortality is due to a high proportion of synchronous malignancies of other organs. There is no difference in patient's satisfaction between the two groups.

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