Total pelvic exenteration for locally advanced and locally recurrent rectal cancer in the elderly
| Autor: | J.A.W. Hagemans, Jacobus W. A. Burger, Eva V. E. Madsen, Joost J. Nuyttens, E. van Meerten, Wim J. Kirkels, Cees Verhoef, Joost Rothbarth, Joost L. Boormans |
|---|---|
| Přispěvatelé: | Surgery, Urology, Medical Oncology, Radiotherapy |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Neoplasm Residual Colorectal cancer medicine.medical_treatment Locally advanced Anastomotic Leak 030230 surgery 03 medical and health sciences 0302 clinical medicine SDG 3 - Good Health and Well-being Overall survival Medicine Humans Neoplasm Invasiveness Recurrent Rectal Cancer Aged Retrospective Studies Pelvic exenteration business.industry Rectal Neoplasms Mortality rate Age Factors General Medicine Chemoradiotherapy Adjuvant Middle Aged medicine.disease Tumour invasion Neoadjuvant Therapy Surgery Pelvic Exenteration Survival Rate Oncology Anastomotic leakage 030220 oncology & carcinogenesis Neoplasm Recurrence Local business |
| Zdroj: | European Journal of Surgical Oncology, 44(10), 1548-1554. W.B. Saunders |
| ISSN: | 0748-7983 |
| DOI: | 10.1016/j.ejso.2018.06.033 |
| Popis: | Total pelvic exenteration (TPE) is a radical approach for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) in case of tumour invasion into the urogenitary tract. The aim of this study is to assess surgical and oncological outcomes of TPE for LARC and LRRC in elderly patients compared to younger patients.All patients who underwent TPE for LARC and LRRC between January 1990 and March 2017 were retrospectively analyzed. Patients aged70 years were classified as younger and ≥70 years as elderly patients.In total 126 patients underwent TPE, of whom 88 younger and 38 elderly patients. Elderly patients had a significantly higher number of ASA II patients (p = 0.01). Indication for surgery LARC (n = 73) and LRRC (n = 53) did not differ significantly. The 30-day mortality rate was significantly higher (p = 0.01) in elderly (13%) compared to younger patients (3%). Elderly patients experienced more anastomotic leakage (p = 0.02). Median overall survival (OS) was 75 months [95%CI 37.1; 112.9] for elderly and 45 months [95%CI 22.4; 67.8] for younger patients (p = 0.77). The 5-year OS rate was 44% in both groups. Median disease specific survival (DSS) was 78 months [95%CI 69.1; 86.9] for elderly and 60 months [95%CI 36.6; 83.4] for younger patients (p = 0.34). The 5-year DSS rate was 57% and 49%, respectively.TPE is an invasive treatment for rectal cancer with high 30-day mortality in elderly patients. Oncological outcomes are similar in elderly and younger patients. Therefore, TPE should not be withheld because of high age only, but careful patient selection is needed. |
| Databáze: | OpenAIRE |
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