Surgical treatment of elderly patients with endometrial cancer (≥ 65 years).
OBJECTIVE
To analyze operability, short-term morbidity and mortality in women aged 65 and older with endometrial cancer.


METHODS
The study cohort consisted of 124 elderly patients, aged 65 and older, with endometrioid endometrial cancer. Patients' clinical data included age at diagnosis, body mass index, ASA (American Society of Anesthesiologists) status and comorbidities, surgical procedures, FIGO (International Federation of Gynecology and Obstetrics) stage, histologic type, occurrence of operative and postoperative complications, and long-term disease-specific survival. Patients were divided into two groups according to age: those < 75 years and those ≥ 75 years. The analysis was repeated for patients older than 80 years who represent the category most at risk for perioperative morbidities.


RESULTS
All patients were referred to primary surgery (abdominal versus vaginal) with the exception of 3 patients. Factors affecting significantly the choice of intervention were age, body mass index, and the presence of comorbidities. No women died during the perioperative period. The rate of perioperative complications was significantly higher for the older group. In a logistic regression model, aged ≥ 75 years (but not aged ≥ 80 years), chronic lung disease and performing lymphadenectomy correlated with a higher probability of perioperative morbidities. Long-term disease-specific survival was significantly shorter only for women aged ≥ 80.


CONCLUSIONS
Geriatric patients should not be denied surgical treatment because of perceived risks associated with chronologic age, since the removal of the uterus confers a survival benefit.
Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy.
Patrizia
P
De Marzi
Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy.
Jessica
J
Ottolina
Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy. Electronic address: mangili.giorgia@hsr.it.
Giorgia
G
Mangili
Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy.
Emanuela
E
Rabaiotti
Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy.
Davide
D
Ferrari
Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy.
Riccardo
R
Viganò
Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy.
Massimo
M
Candiani
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000401:mortality* / Q000601:surgery; D015897:Comorbidity; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
(Common Terminology Criteria for Adverse Events); ASA; American Society of Anesthesiology physical status classes; BMI; BSO; Bilateral Salpingoophorectomy; Body Mass Index; CTCAE; DVT; Deep Vein Thrombosis; Elderly women; Endometrial cancer; FIGO; Gynecological oncologic surgery; International Federation of Gynecology and Obstetrics; Morbidity; Mortality; NS; Not Significant; Perioperative outcome; TIA; Transitory Ischemic Attack; WHO; World Health Organization