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

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.