Is total pelvic exenteration suitable for elderly patients with locally advanced or recurrent rectal cancer?

Nicolae Bacalbasa, ,Doctoral School, “Titu Maiorescu“ University, Bucharest, Romania ,Department Of Surgery, Ponderas Academic Hospital, Bucharest, Romania ,Department Of Surgery, Ramnicu Sarat County Hospital, Buzau, Romania ,Irina Balescu,Adnan Al Aloul

doi:10.37897/rjmp.2021.2.5

Abstract

Locally advanced and relapsed rectal cancer represent one of the most commonly reported indications for total pelvic exenteration especially in men, while in women the surgical procedure might be limited to a posterior exenteration. This procedure is still associated with high risks of postoperative complications and high rates of perioperative mortality, therefore careful selection of the cases is mandatory. However, in the last decades improvement in the field of oncology treatment leaded to the increase of the lifespan of patients diagnosed with rectal cancer; in this respect, it is easy to be understood the fact that an increased number of cases will develop at a certain moment of their evolution pelvic recurrences which need more extended surgical procedures at a more advanced age. Therefore, extended procedures such as pelvic exenterations are needed in these cases; the aim of this paper is to study whether pelvic exenteration is suitable for elderly patients and which cases could benefit most from this aggressive surgical approach.

Highlights

The incidence of colorectal cancer has reported increasing trends worldwide especially due to the relatively facile methods of diagnostic of this pathology, alarming signs and symptoms such as pelvic pain, rectal bleeding and constipation being presented in most cases; the lifespan has significantly increased in the last decades worldwide [1,2,3]
A higher number of patients have been diagnosed with locally advanced or even relapsed rectal cancer at a more advanced age. In this respect, is estimated that up to 10% of patients who had been diagnosed at a certain moment with a rectal tumor will develop at a certain moment of their evolution a pelvic recurrence [4,5]; global increase of the lifespan in association with the progress reported so far in the field of medical oncology conducted to the apparition of this pathology especially in elderly patients [3,4,5]
Elderly patients usually report more significant associated comorbidities, and higher rates of perioperative complications it seems that the long term outcomes are similar between different age groups

Summary

Introduction

The incidence of colorectal cancer has reported increasing trends worldwide especially due to the relatively facile methods of diagnostic of this pathology, alarming signs and symptoms such as pelvic pain, rectal bleeding and constipation being presented in most cases; the lifespan has significantly increased in the last decades worldwide [1,2,3]. A higher number of patients have been diagnosed with locally advanced or even relapsed rectal cancer at a more advanced age. In this respect, is estimated that up to 10% of patients who had been diagnosed at a certain moment with a rectal tumor will develop at a certain moment of their evolution a pelvic recurrence [4,5]; global increase of the lifespan in association with the progress reported so far in the field of medical oncology conducted to the apparition of this pathology especially in elderly patients [3,4,5].

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Results

Conclusion