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Robotic Surgery in Elderly and Very Elderly Gynecologic Cancer Patients.

Abstract：

STUDY OBJECTIVE:To investigate the feasibility, safety, and short-term outcomes of robotic surgery (RS) for gynecologic oncologic indications (cervical, endometrial, and ovarian cancer) in elderly patients, especially women age 65 to 74 years (elderly group [EG]) compared with women age ≥75 years (very elderly group [VEG]). DESIGN:Retrospective cohort study (Canadian Task Force classification II-2). SETTING:Catholic University of the Sacred Heart, Rome, Italy. PATIENTS:Between May 2013 and April 2017, 204 elderly and very elderly patients underwent RS procedures for gynecologic malignancies. RESULTS:The median age was 71 years (range, 65-74 years) in the EG and 77 years (range, 75-87 years) in the VEG. The incidence of cardiovascular disease was higher in the VEG (p = .038). The EG and VEG were comparable in terms of operative time, blood loss, and need for blood transfusion. Almost all (98.5%) of the patients underwent total/radical hysterectomy, 109 patients (55.6% of the EG vs 48.3% of the VEG) underwent pelvic lymphadenectomy, and 19 patients (10.5% of the EG vs 6.7% of the VEG) underwent aortic lymphadenectomy. A total of 7 (3.4%) conversions to open surgery were registered. Only 3 patients required postoperative intensive care unit admission. The median length of hospital stay was 2 days in each group. A total of 11 patients (5.6%) had early postoperative complications. Four patients (2.8%) in the EG and 2 patients (3.3%) in the VEG experienced grade ≥2 complications. At the time of analysis, median follow-up was 18 months (range, 6-55 months). Eleven patients (5.6%) experienced disease relapse, 2 (1%) died of disease, and 3 (1.5%) died of cardiovascular disease. CONCLUSIONS:This study demonstrates the feasibility, safety, and good short-term outcomes of RS in elderly and very elderly gynecologic cancer patients. No patient can be considered too old for a minimally invasive robotic approach, but a multidisciplinary approach is the best management pathway; efforts to reduce associated morbidity are essential.

journal_name

J Minim Invasive Gynecol

journal_title

Journal of minimally invasive gynecology

authors

Gallotta V,Conte C,D'Indinosante M,Federico A,Biscione A,Vizzielli G,Bottoni C,Carbone MV,Legge F,Uccella S,Ciocchetti P,Russo A,Polidori L,Scambia G,Ferrandina G

doi

10.1016/j.jmig.2018.01.007

subject

Has Abstract

pub_date

2018-01-01 00:00:00

pages

872-877

issue

eissn

1553-4650

issn

1553-4669

pii

S1553-4650(18)30040-2

journal_volume

pub_type

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Robotic Surgery in Elderly and Very Elderly Gynecologic Cancer Patients.