title: Impact of age on surgical staging and approaches (laparotomy, laparoscopy and robotic surgery) in endometrial cancer management.
abstract: OBJECTIVE
  This study aims to evaluate the different surgical approaches, perioperative morbidity and surgical staging according to age in patients with endometrial cancer.
  
  
  METHODS
  Multicentre retrospective study. Cancer characteristics and perioperative data were collected for patients surgically treated for endometrial cancer. The patients were divided into 2 groups according to their age: younger or older than 75 years.
  
  
  RESULTS
  Surgery was performed on 270 women <75 years old and on 74 ≥ 75 years old. Minimally invasive surgery was performed less often in the elderly compared with their younger counterparts (58.2% vs. 74.8%; p = 0.006). Independently of the surgical approach, the rate of pelvic and para-aortic lymphadenectomy was lower in women older than 75 years old than their younger counterparts (52.7% vs. 74.8%; p < 0.001; 8.1% vs. 21.8%; p = 0.007 respectively). According to the guidelines, more frequent surgical understaging was seen in the elderly compared with the younger (37% vs. 15.2%; p = 0.002). In the comparison of complications for each surgical approach, there was no statistical difference in the ≥75-year-old age group in terms of intra- or postoperative complications between the laparotomy, laparoscopy or robotic surgery group. We found a shorter length of hospital stay for the women who underwent laparoscopy or robotic surgery compared with laparotomy (p < 0.0001).
  
  
  CONCLUSIONS
  Elderly women with endometrial cancer are often surgically understaged whereas there is no evidence of greater perioperative complications than for their younger counterparts. They should benefit from minimally invasive surgery and optimal surgical staging to the same extent as younger women.
authors.affiliation: Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France. Electronic address: charlottebourgin@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Bourgin
authors.affiliation: Comprehensive Cancer Centre, Department of Surgical Oncology, Institut Paoli Calmette, 223 Boulevard Ste Marguerite, 13009 Marseille, France.
authors.forename: E
authors.initials: E
authors.lastname: Lambaudie
authors.affiliation: Comprehensive Cancer Centre, Department of Surgical Oncology, Institut Paoli Calmette, 223 Boulevard Ste Marguerite, 13009 Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Houvenaeghel
authors.affiliation: Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France.
authors.forename: F
authors.initials: F
authors.lastname: Foucher
authors.affiliation: Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France; INSERM, ER440, Oncogenesis, Stress and Signaling (OSS), Eugène Marquis Comprehensive Cancer Centre, Rennes, France.
authors.forename: J
authors.initials: J
authors.lastname: Levêque
authors.affiliation: Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France; INSERM, ER440, Oncogenesis, Stress and Signaling (OSS), Eugène Marquis Comprehensive Cancer Centre, Rennes, France.
authors.forename: V
authors.initials: V
authors.lastname: Lavoué
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data*; D007902:Length of Stay; D008197:Lymph Node Excision; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D058994:Salpingectomy / Q000379:methods; D055815:Young Adult
keywords: Elderly; Endometrial cancer; Surgical approach; Surgical staging