Safety and tolerance of radical hysterectomy for cervical cancer in the elderly.
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).


CONCLUSIONS
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.
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons.
Erin M
EM
George
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.
Ana I
AI
Tergas
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University.
Cande V
CV
Ananth
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons.
William M
WM
Burke
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons.
Sharyn N
SN
Lewin
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons.
Eri
E
Prendergast
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.
Alfred I
AI
Neugut
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.
Dawn L
DL
Hershman
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.
Jason D
JD
Wright
D000367:Age Factors; D000368:Aged; D000075202:Contraindications; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000601:surgery*
Cervical Carcinoma; Cervical cancer; Elderly; Hysterectomy; Radical hysterectomy; Surgery