Laparoscopic hysterectomy for endometrial cancer: impact of age on clinical outcomes

W. W. Ee (Lead / Corresponding author), V. Nellore, W. McMullen, K. Ragupathy

    Research output: Contribution to journalArticle

    Abstract

    Introduction: Improvement in preoperative care for the ageing population has resulted in an increasing number of elderly patients to be considered for surgery. With an increased incidence of endometrial cancer, it is inevitable that a significant number of elderly patients are referred for surgery, despite the concerns over co-morbid conditions and diminished cardiopulmonary reserves.

    Aim: To evaluate the clinical outcomes of laparoscopic hysterectomy for elderly women operated on for endometrial cancer with comparison to younger patients.

    Methods: A retrospective study of women who had undergone total laparoscopic hysterectomy for endometrial cancer at Ninewells Hospital between January 2015 and January 2017 was conducted. Patients were identified from the gynaecology oncology multidisciplinary team e-case database and were categorised into younger and older group according to their age. Both groups were compared and analysed for demographics details, pre-existing comorbidity, METS score, perioperative and postoperative data.

    Results: There were 100 women meeting the study criteria. Of these, 79 patients were aged ≤75 (Group A) and 21 patients were aged >75 (Group B). The mean age was 62.9 (age range 37-75) and 80.6 (age range 76-90) in Group A and Group B, respectively. Group A presented with higher mean BMI (̄ = 33.8) compared to Group B (̄ = 28.8). With the increase in patient's age, reduced METS score was observed. No difference was found between the groups in the incidence of estimated blood loss and postoperative hospital stay. Fisher's exact test was used to evaluate the postoperative complication in both groups. The two-tailed p value (p = .1108) had illustrated that the observation was statistically insignificant between both groups. One patient in Group A (n = 79) was found to have pelvic haematoma after the procedure; while two patients in Group B (n = 21) developed port site haematoma. Otherwise, no other patients from both groups developed postoperative complication regardless of their pre-existing medical conditions. Only one patient in Group A (n = 79) required conversion to open surgery due to difficult access and large uterine fibroid.

    Conclusions: Total laparoscopic hysterectomy appears to be feasible and safe in elderly women with no significant difference between groups. Minimally invasive surgery has shown to extend considerable benefits to patient safety regardless of their age.

    Original languageEnglish
    Pages (from-to)734
    Number of pages1
    JournalJournal of Obstetrics & Gynaecology
    Volume38
    Issue number5
    Early online date6 Apr 2018
    DOIs
    Publication statusPublished - Jul 2018

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