Robotic surgical management of endometrial cancer in octogenarians and nonagenarians: analysis of perioperative outcomes and review of the literature

Abstract

The primary aim of this article is to report the outcomes of octogenarians and nonagenarians who have undergone robotic surgery for endometrial cancer. A multi-institutional research consortium was created to evaluate the utility of robotics for gynecologic surgery (benign and malignant). IRB approval was obtained at each institution. A multi-institutional HIPPA compliant database was then created and analyzed for all patients that underwent robotic-assisted surgery with staging for endometrial cancer between the April 2003 and January 2009. In total, 395 patients were identified. A subset of patients between the ages of 80 and 95 years were then identified and analyzed for demographic data and perioperative outcomes. Twenty-seven patients in this age group were identified who underwent robotic-assisted hysterectomy and staging. The median age was 84, and median body mass index was 28. Comorbidities such as diabetes mellitus and hypertension were identified in 22 and 74% of patients, respectively. Over one-half (56%) of the patients reported a prior abdominal surgery. Final pathological analysis demonstrated that 88% of all patients had either Stage I or II disease. The median operative time was 192 min. The median estimated blood loss was 50 cc, and the median lymph node count was 16. The median hospital stay was 1.0 day. The overall intraoperative and postoperative complication rate was 7.4 and 33%, respectively. No patient received a blood transfusion. There was one conversion to laparotomy (3.7%). A comparison of the outcomes of the elderly cohort to those of all patients in the database (control group) revealed that there was no statistically significant difference between the groups in terms of operative time, blood loss, hospital stay, nodal yield, or conversion rate. Intraoperative complications were statistically similar between the groups; however, postoperative complications were significantly higher in the elderly cohort. We conclude that robotic surgery is safe, feasible, and expands surgical options for octogenarians and nonagenarians diagnosed with endometrial cancer. Age should not be considered a contraindication for robotic surgical management of patients with endometrial cancer.

Comparison Between Laparoscopic and Robotic Surgery in Elderly Patients With Endometrial Cancer: A Retrospective Multicentric Study

“…Our results did not show a worsening of the surgical outcomes when the age increased, in agreement with Uccella et al who demonstrated the maintenance of an advantage of LS compared with laparotomy even in patients aged 80 years or older (6) and Lowe et al who showed a 96% successful robotic procedures in octogenarians and nonagenarians (33). Furthermore, although Walker et al showed an increased conversion rate (from LS to Laparotomy) for each decade of age (34), our analysis did not reveal any differences in the conversion rate according to the age class.…”

“…who demonstrated the maintenance of an advantage of LS compared with laparotomy even in patients aged 80 years or older ( 6 ) and Lowe et al. who showed a 96% successful robotic procedures in octogenarians and nonagenarians ( 33 ). Furthermore, although Walker et al.…”

Hysterectomy for Uterine Cancer in the Elderly: A Comparison Between Laparoscopic and Robot-Assisted Techniques

“…A study by Lowe et al 22 published their findings on robotic surgery in the elderly in 2010, with data from a database set up by a multi-institutional research consortium over a 6 year period. They identified 27 patients aged 80 to 95 years who underwent robotic-assisted hysterectomy and staging for endometrial cancer and compared their perioperative outcomes to a younger group of 395 patients undergoing the same procedure for the same diagnosis.…”

Health-Related Quality of Life Following Robotic Surgery: A Pilot Study

“…[18][19][20][21] Robotic surgery has been shown to be safe and feasible in patients with endometrial cancer who are at higher risk for complications, such as obese and elderly women. 17,[22][23][24][25] Although robotic surgery is associated with a shorter hospital stay and fewer perioperative and postoperative complications, 26 we currently lack information regarding other elements of QoL that are important factors in a patient's preference for surgical approach. Because of the findings in the LAP2 study 27 that survival is not compromised by use of a minimally invasive approach for surgery in women with uterine cancer, QoL becomes a crucial factor influencing a patient's preference for surgical approach.…”