Surgical outcomes among elderly women with endometrial cancer treated by laparoscopic hysterectomy: a NRG/Gynecologic Oncology Group study.
OBJECTIVE
Tolerance of and complications caused by minimally invasive hysterectomy and staging in the older endometrial cancer population is largely unknown despite the fact that this is the most rapidly growing age group in the United States. The objective of this retrospective review was to compare operative morbidity by age in patients on the Gynecologic Oncology Group Laparoscopic Surgery or Standard Surgery in Treating Patients With Endometrial Cancer or Cancer of the Uterus (LAP2) trial.


STUDY DESIGN
This is a retrospective analysis of patients from Gynecologic Oncology Group LAP2, a trial that included clinically early-stage uterine cancer patients randomized to laparotomy vs laparoscopy for surgical staging. Differences in the rates and types of intraoperative and perioperative complications were compared by age. Specifically complications between patients <60 vs ≥60 years old were compared caused by toxicity analysis showing a sharp increase in toxicity starting at age 60 years in the laparotomy group.


RESULTS
LAP2 included 1477 patients ≥60 years old. As expected, with increasing age there was worsening performance status and disease characteristics including higher rates of serous histology, high-stage disease, and lymphovascular space invasion. There was no significant difference in lymph node dissection rate by age for the entire population or within the laparotomy or laparoscopy groups. Toxicity analysis showed a sharp increase in toxicity seen in patients ≥60 years old in the laparotomy group. Further analysis showed that when comparing laparotomy with laparoscopy in patients <60 years old vs ≥60 years old and controlling for race, body mass index, stage, grade, and performance status, patients <60 years old undergoing laparotomy had more hospital stays >2 days (odds ratio, 17.48; 95% confidence interval, 11.71-27.00, P < .001) compared with patients <60 years old undergoing laparoscopy. However, when comparing laparotomy with laparoscopy in patients ≥60 years old, in addition to hospital stay >2 days (odds ratio, 12.77; 95% confidence interval, 8.74-19.32, P < .001), there were higher rates of the following postoperative complications: antibiotic administration (odds ratio, 1.63; 95% confidence interval, 1.24-2.14, P < .001), ileus (odds ratio, 2.16; 95% confidence interval, 1.42-3.31, P <0.001), pneumonias (odds ratio, 2.36; 95% confidence interval, 1.01-5.66, P = .048), deep vein thromboses (odds ratio, 2.87; 95% confidence interval, 1.08-8.03, P = .035), and arrhythmias (odds ratio, 3.21; 95% confidence interval, 1.60-6.65, P = .001) in the laparotomy group.


CONCLUSION
Laparoscopic staging for uterine cancer is associated with decreased morbidity in the immediate postoperative period in patients ≥60 years old. These results allow for more accurate preoperative counseling. A minimally invasive approach to uterine cancer staging may decrease morbidity that could affect long-term survival.
['Bishop|Erin A|EA|', 'Java|James J|JJ|', 'Moore|Kathleen N|KN|', 'Spirtos|Nick M|NM|', 'Pearl|Michael L|ML|', 'Zivanovic|Oliver|O|', 'Kushner|David M|DM|', 'Backes|Floor|F|', 'Hamilton|Chad A|CA|', 'Geller|Melissa A|MA|', 'Hurteau|Jean|J|', 'Mathews|Cara|C|', 'Wenham|Robert M|RM|', 'Ramirez|Pedro T|PT|', 'Zweizig|Susan|S|', 'Walker|Joan L|JL|']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D001145:Arrhythmias, Cardiac D018269:Carcinoma, Endometrioid D016889:Endometrial Neoplasms D005260:Female D006801:Humans D007044:Hysterectomy D045823:Ileus D007431:Intraoperative Complications D010535:Laparoscopy D007813:Laparotomy D007902:Length of Stay D008875:Middle Aged D009361:Neoplasm Invasiveness D011014:Pneumonia D011183:Postoperative Complications D012189:Retrospective Studies D020246:Venous Thrombosis
endometrial older LAP2