Erin M George1, Ana I Tergas2, Cande V Ananth3, William M Burke1, Sharyn N Lewin4, Eri Prendergast1, Alfred I Neugut5, Dawn L Hershman5, Jason D Wright6. 1. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons. 2. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons. 3. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University. 4. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons. 5. Department of Medicine, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons. 6. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons. Electronic address: jw2459@columbia.edu.
Abstract
BACKGROUND: Despite institutional studies that suggest that radical hysterectomy for cervical cancer is well tolerated in the elderly, little population-level data are available on the procedure's outcomes in older women. We performed a population-based analysis to determine the morbidity, mortality, and resource utilization of radical hysterectomy in elderly women with cervical cancer. METHODS: Patients recorded in the Nationwide Inpatient Sample with invasive cervical cancer who underwent abdominal radical hysterectomy between 1998 and 2010 were analyzed. Patients were stratified by age: <50, 50-59, 60-69, and ≥70 years. We examined the association between age and the outcomes of interest using chi square tests and multivariable generalized estimating equations. RESULTS: A total of 8199 women were identified, including 768 (9.4%) women age 60-69 and 462 (5.6%) women ≥70 years of age. All cause morbidity increased from 22.1% in women <50, to 24.7% in those 50-59 years, 31.4% in patients 60-69 years and 34.9% in women >70years of age (P<0.0001). Compared to women<50, those >70 were more likely to have intraoperative complications (4.8% vs. 9.1%, P=0.0003), surgical site complications (10.9% vs. 17.5%, P<0.0001), and medical complications (9.9% vs. 19.5%, P<0.0001). The risk of non-routine discharge (to a nursing facility) was 0.5% in women <50 vs. 12.3% in women ≥70 (P<0.0001). Perioperative mortality women ≥70 years of age was 30 times greater than that of women <50 (P<0.0001). CONCLUSION: Perioperative morbidity and mortality are substantially greater in elderly women who undergo radical hysterectomy for cervical cancer. Non-surgical treatments should be considered in these patients.
BACKGROUND: Despite institutional studies that suggest that radical hysterectomy for cervical cancer is well tolerated in the elderly, little population-level data are available on the procedure's outcomes in older women. We performed a population-based analysis to determine the morbidity, mortality, and resource utilization of radical hysterectomy in elderly women with cervical cancer. METHODS:Patients recorded in the Nationwide Inpatient Sample with invasive cervical cancer who underwent abdominal radical hysterectomy between 1998 and 2010 were analyzed. Patients were stratified by age: <50, 50-59, 60-69, and ≥70 years. We examined the association between age and the outcomes of interest using chi square tests and multivariable generalized estimating equations. RESULTS: A total of 8199 women were identified, including 768 (9.4%) women age 60-69 and 462 (5.6%) women ≥70 years of age. All cause morbidity increased from 22.1% in women <50, to 24.7% in those 50-59 years, 31.4% in patients 60-69 years and 34.9% in women >70years of age (P<0.0001). Compared to women<50, those >70 were more likely to have intraoperative complications (4.8% vs. 9.1%, P=0.0003), surgical site complications (10.9% vs. 17.5%, P<0.0001), and medical complications (9.9% vs. 19.5%, P<0.0001). The risk of non-routine discharge (to a nursing facility) was 0.5% in women <50 vs. 12.3% in women ≥70 (P<0.0001). Perioperative mortality women ≥70 years of age was 30 times greater than that of women <50 (P<0.0001). CONCLUSION: Perioperative morbidity and mortality are substantially greater in elderly women who undergo radical hysterectomy for cervical cancer. Non-surgical treatments should be considered in these patients.
Authors: T Pignon; J C Horiot; M Bolla; H van Poppel; H Bartelink; F Roelofsen; F Pene; A Gerard; N Einhorn; T D Nguyen; M Vanglabbeke; P Scalliet Journal: Radiother Oncol Date: 1997-02 Impact factor: 6.280
Authors: F Landoni; A Maneo; A Colombo; F Placa; R Milani; P Perego; G Favini; L Ferri; C Mangioni Journal: Lancet Date: 1997-08-23 Impact factor: 79.321
Authors: B Zachariah; L Balducci; G V Venkattaramanabalaji; L Casey; H M Greenberg; J A DelRegato Journal: Int J Radiat Oncol Biol Phys Date: 1997-12-01 Impact factor: 7.038
Authors: Jiawei Yuan; Bradley Malin; François Modave; Yi Guo; William R Hogan; Elizabeth Shenkman; Jiang Bian Journal: J Biomed Inform Date: 2016-12-19 Impact factor: 6.317
Authors: Jason D Wright; Ling Chen; Ana I Tergas; William M Burke; June Y Hou; Alfred I Neugut; Cande V Ananth; Dawn L Hershman Journal: Am J Obstet Gynecol Date: 2015-07-23 Impact factor: 8.661
Authors: E M George; W M Burke; J Y Hou; A I Tergas; L Chen; A I Neugut; C V Ananth; D L Hershman; J D Wright Journal: BJOG Date: 2015-08-23 Impact factor: 6.531