PURPOSE: Bowel function after low anterior resection for rectal cancer with co lonic J-pouch reconstruction is more normal than after conventional straight an astomosis. However, few reports have examined the function of colonic J-pouch r econstruction in the elderly. Good function would obviate the need for colostomy , which is sometimes performed because of concern about fecal incontinence, whic h increases with age. This study evaluated the function of colonic J-pouch reco nstruction in elderly patients aged 75 years or older. METHODS: Functional outco me was compared in 20 patients aged 75 years or older (older group) and 27 patie nts aged 60 to 74 years (old group) and 60 patients aged 59 years or younger (yo ung group), 3 years after colonic J-pouch reconstruction, using a functional sc oring system with a 17-item questionnaire (score range, 0 (overall good) to 26 (overall poor)). RESULTS: The functional scores in the three age groups were sat isfactory and similar. Among patients with anastomoses 1 cm to 4 cm from the ana l verge, all 17 categories on the questionnaire in the three age groups were sim ilar. Among patients with anastomoses 5 cm to 8 cm from the anal verge, only the use of laxatives or glycerine enemas was more common in the older group than in the old and young group (90 vs. 38.5 percent and 43.3 percent; P = 0.01). CONCL USIONS: Low anterior resection with colonic J-pouch reconstruction provides exc ellent functional outcome, including continence, for elderly patients. Colonic J -pouch reconstruction is a highly preferable alternative to permanent colostomy in elderly patients undergoing low anterior resection. PURPOSE: Bowel function after low anterior resection for rectal cancer with co lonic J-pouch reconstruction is more normal than after conventional straight an astomosis. However, few reports have examined the function of colonic J-pouch r econstruction in the elderly. Good function would obviate the need for colostomy, which is sometimes performed because of concern about fecal incontinence, whic h increases with age. This study evaluating the function of colonic J-pouch reco nstruction in elderly patients aged 75 years or older. METHODS: Functional outco me was compared in 20 patients aged 75 years or older (older group) and 27 patience aged 60 to 74 years (old group) and 60 patients aged 59 years or younger (yo ung group), 3 years after colonic J-pouch reconstruction, using a functional scoring system with a 17-item questionnaire (score range, 0 (overall good) to 26 (overall poor)). RESULTS: The functional scores in the three age groups were sat isfactory and similar. s with anastomoses 1 cm to 4 cm from the ana l verge, all 17 categories on the questionnaire in the three age groups were sim ilar. Among patients with anastomoses 5 cm to 8 cm from the anal verge, only the use of laxatives or glycerine CONCL USIONS: Low anterior resection with colonic J-pouch provides exclent features, including continence (90 vs. 38.5 percent and 43.3 percent; P = 0.01) , for elderly patients. Colonic J -pouch reconstruction is a highly preferable alternative to permanent colostomy in elderly patients undergoing low anterior resection.