title: Laparoscopic vs. open treatment of endometrial cancer in the elderly and very elderly: An age-stratified multicenter study on 1606 women.
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 (
  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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. Electronic address: stefucc@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.affiliation: Epidemiology and Preventive Medicine Research Centre, Insubria University, Varese, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bonzini
authors.affiliation: Unit of Obstetrics and Gynecology, IRCCS - ASMN of Reggio Emilia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Palomba
authors.affiliation: 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.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.affiliation: Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Malzoni
authors.affiliation: Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Ceccaroni
authors.affiliation: Minimally-Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Seracchioli
authors.affiliation: Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Ferrero
authors.affiliation: Department of Gynecology and Obstetrics, University of Parma, Parma, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Berretta
authors.affiliation: Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizza
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Sturla
authors.affiliation: Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Roviglione
authors.affiliation: Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Monterossi
authors.affiliation: Minimally-Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Casadio
authors.affiliation: Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Volpi
authors.affiliation: Department of Gynecology and Obstetrics, University of Parma, Parma, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Mautone
authors.affiliation: Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Corrado
authors.affiliation: Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bruni
authors.affiliation: Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D010052:Ovariectomy / Q000379:methods; D012189:Retrospective Studies; D058994:Salpingectomy / Q000379:methods
keywords: Aging; Elderly; Endometrial cancer; Laparoscopy; Minimally-invasive; Surgery