Perioperative and Long-term Outcomes of Laparoscopic, Open Abdominal, and Vaginal Surgery for Endometrial Cancer in Patients Aged 80 Years or Older

Bogani, Giorgio MD; Cromi, Antonella PhD; Uccella, Stefano MD; Serati, Maurizio MD; Casarin, Jvan MD; Pinelli, Ciro MD; Ghezzi, Fabio MD

International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0000000000000128
Uterine Cancer
Abstract

Objective: This study was undertaken to evaluate the safety, feasibility, and the long-term effectiveness of laparoscopy in endometrial cancer patients aged 80 years or older.

Methods: Data of consecutive patients aged 80 years and older undergoing laparoscopic, open abdominal, and vaginal approaches were compared. Postoperative complications were graded per the Accordion Severity Classification. Survival outcomes within the first 5 years were analyzed using the Kaplan-Meier method.

Results: Among 726 patients, 63 (9%) were aged 80 years and older. Laparoscopic, open abdominal, and vaginal surgery were performed in 22 (35%), 25 (40%), and 16 (25%) cases, respectively. All laparoscopic procedures were completed laparoscopically, whereas a conversion from vaginal to open procedure occurred (0% vs 6%; P = 0.42). Patients undergoing laparoscopy experienced similar operative time (P > 0.05), lower blood loss (P < 0.05), and shorter hospital stay (P < 0.05) than patients undergoing open and vaginal surgery. No intraoperative complications were recorded. Laparoscopy is related to a lower rate of postoperative complications (P = 0.09) and Accordion grade greater than or equal to 2 complications (P = 0.05) in comparison to open abdominal and vaginal surgery. The route of surgical approaches did not influence the 5-year disease-free (P = 0.97, log-rank test) and overall (P = 0.94, log-rank test) survivals.

Conclusions: Laparoscopy seems to represent a safe and effective treatment of endometrial cancer in women aged 80 years or older. Our data suggest that in elderly women, laparoscopic surgery improves perioperative outcomes compared with open and vaginal approaches without compromising long-term survival.

Author Information

Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.

Address correspondence and reprint requests to Giorgio Bogani, MD, Department Obstetrics and Gynecology, University of Insubria, Piazza Biroldi 1, Varese 21100, Italy. E-mail: giorgiobogani@yahoo.it.

The study was conducted in Varese, Italy.

No funding sources supported this investigation.

The authors declare no conflicts of interest.

Received January 9, 2014

Accepted February 23, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.