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

Affiliation

Alahmadi R(1), Steffens D(2)(3), Solomon MJ(4)(5)(6)(7), Lee PJ(1)(2)(8), Austin KKS(1)(2), Koh CE(1)(2)(3)(8).
Author information:
(1)Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
(2)Surgical Outcomes Research Centre
(SOuRCe), Royal Prince Alfred Hospital, University of Sydney, Sydney Local Health District, New South Wales, Australia.
(3)Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.
(4)Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. [Email]
(5)Surgical Outcomes Research Centre
(SOuRCe), Royal Prince Alfred Hospital, University of Sydney, Sydney Local Health District, New South Wales, Australia. [Email]
(6)Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia. [Email]
(7)RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia. [Email]
(8)RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.

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.