Valerio Gallotta1, Carmine Conte2, Marco D'Indinosante2, Alex Federico2, Antonella Biscione2, Giuseppe Vizzielli2, Carolina Bottoni2, Maria Vittoria Carbone2, Francesco Legge3, Stefano Uccella2, Pierpaolo Ciocchetti4, Andrea Russo4, Lorenzo Polidori4, Giovanni Scambia2, Gabriella Ferrandina5. 1. Department of Gynecologic Oncology, A. Gemelli University Hospital Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy. Electronic address: gallottav@gmail.com. 2. Department of Gynecologic Oncology, A. Gemelli University Hospital Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy. 3. Division of Gynecology, Department of Obstetrics and Gynecology, F. Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy. 4. Anesthesiology and Intensive Care, A. Gemelli University Hospital Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy. 5. Department of Gynecologic Oncology, A. Gemelli University Hospital Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy; Department of Health Science and Medicine, University of Molise, Campobasso, Italy.
Abstract
STUDY OBJECTIVE: To investigate the feasibility, safety, and short-term outcomes of robotic surgery (RS) for gynecologic oncologic indications (cervical, endometrial, and ovarian cancer) in elderly patients, especially women age 65 to 74 years (elderly group [EG]) compared with women age ≥75 years (very elderly group [VEG]). DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Catholic University of the Sacred Heart, Rome, Italy. PATIENTS: Between May 2013 and April 2017, 204 elderly and very elderly patients underwent RS procedures for gynecologic malignancies. RESULTS: The median age was 71 years (range, 65-74 years) in the EG and 77 years (range, 75-87 years) in the VEG. The incidence of cardiovascular disease was higher in the VEG (p = .038). The EG and VEG were comparable in terms of operative time, blood loss, and need for blood transfusion. Almost all (98.5%) of the patients underwent total/radical hysterectomy, 109 patients (55.6% of the EG vs 48.3% of the VEG) underwent pelvic lymphadenectomy, and 19 patients (10.5% of the EG vs 6.7% of the VEG) underwent aortic lymphadenectomy. A total of 7 (3.4%) conversions to open surgery were registered. Only 3 patients required postoperative intensive care unit admission. The median length of hospital stay was 2 days in each group. A total of 11 patients (5.6%) had early postoperative complications. Four patients (2.8%) in the EG and 2 patients (3.3%) in the VEG experienced grade ≥2 complications. At the time of analysis, median follow-up was 18 months (range, 6-55 months). Eleven patients (5.6%) experienced disease relapse, 2 (1%) died of disease, and 3 (1.5%) died of cardiovascular disease. CONCLUSIONS: This study demonstrates the feasibility, safety, and good short-term outcomes of RS in elderly and very elderly gynecologic cancer patients. No patient can be considered too old for a minimally invasive robotic approach, but a multidisciplinary approach is the best management pathway; efforts to reduce associated morbidity are essential.
STUDY OBJECTIVE: To investigate the feasibility, safety, and short-term outcomes of robotic surgery (RS) for gynecologic oncologic indications (cervical, endometrial, and ovarian cancer) in elderly patients, especially women age 65 to 74 years (elderly group [EG]) compared with women age ≥75 years (very elderly group [VEG]). DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Catholic University of the Sacred Heart, Rome, Italy. PATIENTS: Between May 2013 and April 2017, 204 elderly and very elderly patients underwent RS procedures for gynecologic malignancies. RESULTS: The median age was 71 years (range, 65-74 years) in the EG and 77 years (range, 75-87 years) in the VEG. The incidence of cardiovascular disease was higher in the VEG (p = .038). The EG and VEG were comparable in terms of operative time, blood loss, and need for blood transfusion. Almost all (98.5%) of the patients underwent total/radical hysterectomy, 109 patients (55.6% of the EG vs 48.3% of the VEG) underwent pelvic lymphadenectomy, and 19 patients (10.5% of the EG vs 6.7% of the VEG) underwent aortic lymphadenectomy. A total of 7 (3.4%) conversions to open surgery were registered. Only 3 patients required postoperative intensive care unit admission. The median length of hospital stay was 2 days in each group. A total of 11 patients (5.6%) had early postoperative complications. Four patients (2.8%) in the EG and 2 patients (3.3%) in the VEG experienced grade ≥2 complications. At the time of analysis, median follow-up was 18 months (range, 6-55 months). Eleven patients (5.6%) experienced disease relapse, 2 (1%) died of disease, and 3 (1.5%) died of cardiovascular disease. CONCLUSIONS: This study demonstrates the feasibility, safety, and good short-term outcomes of RS in elderly and very elderly gynecologic cancerpatients. No patient can be considered too old for a minimally invasive robotic approach, but a multidisciplinary approach is the best management pathway; efforts to reduce associated morbidity are essential.
Authors: Anna Franca Cavaliere; Federica Perelli; Simona Zaami; Marco D'Indinosante; Irene Turrini; Marco Giusti; Giuseppe Gullo; Giuseppe Vizzielli; Alberto Mattei; Giovanni Scambia; Annalisa Vidiri; Fabrizio Signore Journal: Int J Mol Sci Date: 2021-11-12 Impact factor: 5.923