title: Pelvic exenteration for advanced malignancy in elderly patients.
abstract: BACKGROUND
  Pelvic exenteration is an aggressive surgical procedure reserved for highly selected patients. Surgery in the elderly is often associated with increased morbidity and mortality. The aim of this study was to review outcomes following exenteration for advanced pelvic malignancy in this subgroup of patients.
  
  
  METHODS
  All patients aged 70 years and over who underwent pelvic exenteration between 1999 and 2014 were included in the study. This comprised all primary rectal, gynaecological and bladder tumours. The primary outcome measure was 5-year overall survival. Secondary endpoints were postoperative morbidity and 30-day mortality.
  
  
  RESULTS
  A total of 94 patients were included, with a median age of 76 (range 70-90) years. There were 65 rectal, 20 gynaecological and nine bladder tumours. The administration of neoadjuvant therapy was significantly different among tumour types (P = 0·002). A total of 32 patients (34 per cent) developed postoperative complications, and there were six deaths (6 per cent) within 30 days of surgery. Median survival was 64 months for patients with rectal cancer, 30 months for those with gynaecological tumours and 15 months for those with bladder cancer. Five-year survival rates in these groups were 47, 31 and 22 per cent respectively (P = 0·023).
  
  
  CONCLUSIONS
  Given the possibility of long-term survival, pelvic exenteration should not be withheld on the grounds of advanced age alone.
authors.affiliation: Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: R W
authors.initials: RW
authors.lastname: Radwan
authors.affiliation: Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Evans
authors.affiliation: Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: M
authors.initials: M
authors.lastname: Davies
authors.affiliation: Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Harris
authors.affiliation: Swansea Pelvic Oncology Group, Abertawe Bro Morgannwg University Local Health Board, Swansea, UK.
authors.forename: J
authors.initials: J
authors.lastname: Beynon
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods / Q000401:mortality; D010385:Pelvic Exenteration / Q000379:methods* / Q000401:mortality; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*