Stefano Uccella1, Matteo Bonzini2, Stefano Palomba3, Francesco Fanfani4, Mario Malzoni5, Marcello Ceccaroni6, Renato Seracchioli7, Annamaria Ferrero8, Roberto Berretta9, Enrico Vizza10, Davide Sturla11, Giovanni Roviglione6, Giorgia Monterossi12, Paolo Casadio7, Eugenio Volpi8, Daniele Mautone9, Giacomo Corrado10, Francesco Bruni6, Giovanni Scambia12, Fabio Ghezzi11. 1. Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. Electronic address: stefucc@libero.it. 2. Epidemiology and Preventive Medicine Research Centre, Insubria University, Varese, Italy. 3. Unit of Obstetrics and Gynecology, IRCCS - ASMN of Reggio Emilia, Italy. 4. Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy; Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio" of Chieti-Pescara, Italy. 5. Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy. 6. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy. 7. Minimally-Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 8. Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy. 9. Department of Gynecology and Obstetrics, University of Parma, Parma, Italy. 10. Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy. 11. Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. 12. Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.
Abstract
Objective To investigate in depth the effect of increasing age on the peri-operative outcomes of laparoscopic treatment for endometrial cancer, compared to open surgery, with stratification of patients according to the different definitions of elderly age used in the literature. METHODS: Data of consecutive patients who underwent surgery for endometrial cancer staging at six centers were reviewed and analyzed according to surgical approach (laparoscopic or open), different definitions of elderly and very elderly age (≥65years, ≥75years, ≥80years), and class of age (<65; ≥65-<75; ≥75-80; ≥80years). Multivariable analysis to correct for possible confounders and propensity-score matching to minimize selection bias were used. RESULTS: A total of 1606 patients were included: 938 and 668 patients received laparoscopic and open surgery, respectively. With increasing age, fewer patients received laparoscopy (P<0.001 with ANOVA). The percentage of patients who received lymphadenectomy declined significantly in both groups for age ≥80years. Blood transfusions, incidence and severity of post-operative complications, and hospital stay were significantly lower among patients who had laparoscopy both in younger (<65years) and elderly (whether defined as ≥65 or ≥75years) patients, with no effect of age on any of the characteristics analyzed ( ANOVA: P>0.05). The same tendency was observed among very-elderly patients (≥80years). Multivariable and propensity score-matched analysis confirmed these findings. CONCLUSIONS: Laparoscopy for staging endometrial cancer retains its advantages over open surgery even in elderly and very-elderly patients. Our data strongly suggest that minimally-invasive surgery is advantageous even among subjects ≥80years.
Objective To investigate in depth the effect of increasing age on the peri-operative outcomes of laparoscopic treatment for endometrial cancer, compared to open surgery, with stratification of patients according to the different definitions of elderly age used in the literature. METHODS: Data of consecutive patients who underwent surgery for endometrial cancer staging at six centers were reviewed and analyzed according to surgical approach (laparoscopic or open), different definitions of elderly and very elderly age (≥65years, ≥75years, ≥80years), and class of age (<65; ≥65-<75; ≥75-80; ≥80years). Multivariable analysis to correct for possible confounders and propensity-score matching to minimize selection bias were used. RESULTS: A total of 1606 patients were included: 938 and 668 patients received laparoscopic and open surgery, respectively. With increasing age, fewer patients received laparoscopy (P<0.001 with ANOVA). The percentage of patients who received lymphadenectomy declined significantly in both groups for age ≥80years. Blood transfusions, incidence and severity of post-operative complications, and hospital stay were significantly lower among patients who had laparoscopy both in younger (<65years) and elderly (whether defined as ≥65 or ≥75years) patients, with no effect of age on any of the characteristics analyzed ( ANOVA: P>0.05). The same tendency was observed among very-elderly patients (≥80years). Multivariable and propensity score-matched analysis confirmed these findings. CONCLUSIONS: Laparoscopy for staging endometrial cancer retains its advantages over open surgery even in elderly and very-elderly patients. Our data strongly suggest that minimally-invasive surgery is advantageous even among subjects ≥80years.
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Authors: Justine M Briët; Marian Je Mourits; Barbara L van Leeuwen; Edwin R van den Heuvel; Monique Ja Kenkhuis; Henriette Jg Arts; Geertruida H de Bock Journal: Clin Interv Aging Date: 2018-12-13 Impact factor: 4.458
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