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Elderly Patients Have Better Quality of Life but Worse Survival Following Pelvic Exenteration: A 25-Year Single-Center Experience

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

To describe quality of life (QOL) and survival outcomes following pelvic exenteration (PE) in old and young patients.

Background

PE is a management option for complete resection in locally advanced pelvic cancers. Few studies have examined the impact of age on the outcome in elderly patients following PE.

Patients and Methods

Prospective cohort of consecutive patients undergoing partial and complete PE between 1994 and 2019. Patients were divided into a younger (< 65 years) or older cohort (≥ 65 years) based on their age. QoL was assessed using the SF-36 and FACT-C questionnaires and survival estimated using the Kaplan–Meier method.

Results

For 710 patients who underwent PE during the study period, FACT-C total score was significantly better in the elderly during the whole follow-up period of 5 years. Mental component score (SF-36) was significantly better at baseline (p = 0.008) and at 24 months postoperatively (p = 0.042), in the elderly group. Median overall survival was 75 months in the younger cohort and 53 months in the older cohort (p = 0.004). In subgroup analysis, older patients with recurrent or primary rectal cancer had a median survival of 37 and 70 months, respectively. Postoperative cardiovascular complications were greater in the elderly cohort (p < 0.001).

Conclusions

Elderly patients had better overall QoL but lower survival that is probably related to cardiovascular complications rather than to cancer as both groups had similar R0 resection rate. Hence, the elderly population should be considered equally for PE.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

    Raha Alahmadi MD, Michael J. Solomon MD, Peter J. Lee MD, FRACS, MS, Kirk K. S. Austin MD & Cherry E. Koh MD

  2. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, University of Sydney, Sydney Local Health District, New South Wales, Australia

    Daniel Steffens Ph.D, Michael J. Solomon MD, Peter J. Lee MD, FRACS, MS, Kirk K. S. Austin MD & Cherry E. Koh MD

  3. Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia

    Daniel Steffens Ph.D, Michael J. Solomon MD & Cherry E. Koh MD

  4. RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia

    Michael J. Solomon MD, Peter J. Lee MD, FRACS, MS & Cherry E. Koh MD

Authors
  1. Raha Alahmadi MD
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  2. Daniel Steffens Ph.D
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  3. Michael J. Solomon MD
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Correspondence to Michael J. Solomon MD.

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Alahmadi, R., Steffens, D., Solomon, M.J. et al. Elderly Patients Have Better Quality of Life but Worse Survival Following Pelvic Exenteration: A 25-Year Single-Center Experience. Ann Surg Oncol 28, 5226–5235 (2021). https://doi.org/10.1245/s10434-021-09685-6

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  • DOI: https://doi.org/10.1245/s10434-021-09685-6

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