Impact of age on surgical staging and approaches (laparotomy, laparoscopy and robotic surgery) in endometrial cancer management

Bourgin, Charlotte; Lambaudie, Éric; Houvenæghel, Gilles; Foucher, Fabrice; Lévèque, J; Lavoué, Vincent

doi:10.1016/j.ejso.2016.10.022

Cited by 31 publications

(36 citation statements)

References 27 publications

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“…This association may be due to an increased perioperative risk, but may also be influenced by a bias on the part of some surgeons 19 . Our findings corroborate previous reports on more limited surgery in older patients 18,23 . Some studies have suggested a higher perioperative complication rate and a longer length of stay associated with advanced patient age, even when stratified by comorbidities 23 .…”

Section: Discussionsupporting

confidence: 87%

“…They are at higher risk for competing events which may limit their overall survival 14,15 . These women’s age and health status may also influence management decisions by their healthcare providers, including the extent of surgical staging and recommendations for adjuvant treatment; 16‐19 this may result in undertreatment in this patient population. Finally, older age has been associated with more advanced disease and with more aggressive histological subtypes of endometrial cancer, such as high grade tumors and non‐endometrioid histologies 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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Age is an independent predictor of outcome in endometrial cancer patients: An Israeli Gynecology Oncology Group cohort study

Hag-Yahia

Gemer

Eitan

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Advanced age is considered an adverse factor in endometrial cancers but may be a surrogate for other conditions that impact outcomes. The study objective was to assess the association of age with endometrial cancer features, treatment and prognosis. Material and methods In this multicenter cohort study, consecutive women with endometrial cancer treated at 10 Israeli institutions between 2000 and 2014 were accrued in an assimilated database. Postmenopausal women were stratified into age groups with a cut‐off of 80. Clinical, pathological and treatment data were compared using t test or Mann‐Whitney test for continuous variables, and Chi‐square Test or Fisher’s Exact test for categorical variables. Main outcome measures included disease recurrence and disease‐specific and overall survival; these were plotted using the Kaplan‐Meier method and compared using the log‐rank test. The association between age and recurrence and survival, adjusted for other clinical and pathological factors, was assessed using multivariable Cox regression modeling. Results A total of 1764 postmenopausal women with endometrial cancer were identified. Adverse pathological features were more prevalent in older women, including high‐risk histologies (35% vs 27%, P = .025), deep myoinvasion (44% vs 29%, P = .001) and lymphovascular involvement (22% vs 15%, P = .024). Surgical staging was performed less frequently among older women (33% vs 56%; P < .001). Chemotherapy was less often prescribed, even for non‐endometrioid histologies (72% vs 45%; P < .001). On multivariable analysis, age remained a significant predictor for recurrence (HR = 1.75, P = .007), death of disease (HR = 1.89, P = .003) and death (HR = 2.4, P < .001). Conclusions Older age in women with endometrial cancer is associated with more adverse disease features, limited surgery and adjuvant treatment, and worse outcomes. On multivariable analysis, age remains an independent prognosticator in this population.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Age is an independent predictor of outcome in endometrial cancer patients: An Israeli Gynecology Oncology Group cohort study

Hag-Yahia

Gemer

Eitan

et al. 2020

Acta Obstet Gynecol Scand

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“…In our study, 16.5% patients received laparoscopy. The innovative technology even reduces the risk of surgery in older women, which may expand the scope of lymph node clearance [33]. At the same time, the introduction of sentinel lymph node mapping may further reduce surgical trauma.…”

Section: Discussionmentioning

confidence: 99%

Cervical invasion, lymphovascular space invasion, and ovarian metastasis as predictors of lymph node metastasis and poor outcome on stages I to III endometrial cancers: a single-center retrospective study

Xie

et al. 2019

World J Surg Onc

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BackgroundThe aim of this study is to determine pathological factors that increase the risk of LNM and indicate poor survival of patients diagnosed with endometrial cancer and treated with surgical staging.MethodBetween January 2010 and November 2018, we enrolled 874 eligible patients who received staging surgery in the First Affiliated Hospital of Anhui Medical University. The roles of prognostic risk factors, such as age, histological subtype, tumor grade, myometrial infiltration, tumor diameter, cervical infiltration, lymphopoiesis space invasion (LVSI), CA125, and ascites, were evaluated. Multivariable logistic regression models were used to identify the predictors of LNM. Kaplan–Meier and COX regression models were utilized to study the overall survival.ResultsMultivariable regression analysis confirmed cervical stromal invasion (OR 3.412, 95% CI 1.631–7.141; P < 0.01), LVSI (OR 2.542, 95% CI 1.061–6.004; P = 0.04) and ovarian metastasis (OR 6.236, 95% CI 1.561–24.904; P = 0.01) as significant predictors of nodal dissemination. Furthermore, pathological pattern (P = 0.03), myometrial invasion (OR 2.70, 95% CI 1.139–6.40; P = 0.01), and lymph node metastasis (OR 9.675, 95% CI 3.708–25.245; P < 0.01) were independent predictors of decreased overall survival.ConclusionsCervical invasion, lymphopoiesis space invasion, and ovarian metastasis significantly convey the risk of LNM. Pathological type, myometrial invasion, and lymph node metastasis are all important predictors of survival and should be scheduled for completion when possible in the surgical staging procedure.

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“…La littérature ne montre pas de bénéfice prouvé à la chirurgie robotique par rapport à la laparoscopie [4], [12], [13] pour l'hystérectomie « tout venant ». Par contre il existe un bénéfice à la chirurgie robotique dans les situations de chirurgie complexe soit par le terrain (chez les patientes obèses et super obèses [2], [9], [10], [14]), soit par l'indication (chirurgie oncologique [1], [4], [5], [15], [16] ou de l'endométriose profonde [6], [7]) en termes de diminution du taux de laparoconversion ou du taux de complications post-opératoires.…”

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Implantation d’un programme de chirurgie robotique gynécologique : leçons à retenir des 100 premières procédures

Gest

Timoh

Chmielewski

et al. 2019

Gynécologie Obstétrique Fertilité & Sénologie

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Impact of age on surgical staging and approaches (laparotomy, laparoscopy and robotic surgery) in endometrial cancer management

Cited by 31 publications

References 27 publications

Age is an independent predictor of outcome in endometrial cancer patients: An Israeli Gynecology Oncology Group cohort study

Age is an independent predictor of outcome in endometrial cancer patients: An Israeli Gynecology Oncology Group cohort study

Cervical invasion, lymphovascular space invasion, and ovarian metastasis as predictors of lymph node metastasis and poor outcome on stages I to III endometrial cancers: a single-center retrospective study

Implantation d’un programme de chirurgie robotique gynécologique : leçons à retenir des 100 premières procédures

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