Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, 21100 Varese, Italy.
Menopause. 2010 May-Jun;17(3):539-44. doi: 10.1097/gme.0b013e3181c4e9f5.
The aim of this study was to evaluate the feasibility and safety of laparoscopic surgical management of apparently early-stage endometrial cancer in older women and to compare clinical outcomes between older and younger women.
Our prospective oncological database was retrospectively reviewed to identify all consecutive women who underwent surgery for endometrial cancer from 2002. Data available included information about demography, comorbidities, surgical outcomes, histology, adjuvant therapies, and follow-up. Women were divided in two groups according to age (older, >65 y, and younger, < or =65 y). Univariate and multivariate analyses were performed to identify factors that negatively impact disease-free and overall survival.
A total of 48 (44.4%) older and 60 (55.6%) younger women were included. Groups were comparable in operative time, blood loss, need for blood transfusions, nodal count, and intraoperative and postoperative complications. Cancer in older women was more frequently upstaged than that in younger women (17 [35.4%] vs 8 [13.3%], respectively; P = 0.01). The 2- and 5-year disease-free survival rates were 82% versus 96% (P = 0.003) and 74% versus 93% (P = 0.0005) and the overall 2- and 5-year survival rates were 87% versus 98% (P = 0.006) and 83% versus 95% (P = 0.01) for older and younger women, respectively. Multivariate analysis showed that advanced surgical stage, unfavorable histology, high-grade tumors (grade 3), and deep myometrial invasion (>50%) are independent risk factors for recurrence.
In the absence of absolute anesthesia contraindications, laparoscopy seems to be feasible and safe in older women with endometrial cancer. Comprehensive surgical staging should be offered, regardless of age, to avoid understaging and to optimize treatment strategies.
本研究旨在评估腹腔镜手术治疗老年早期子宫内膜癌的可行性和安全性，并比较老年和年轻女性的临床结局。
我们回顾性地分析了 2002 年以来所有连续接受手术治疗子宫内膜癌的女性的前瞻性肿瘤数据库。可获得的数据包括人口统计学资料、合并症、手术结果、组织学、辅助治疗和随访情况。根据年龄（>65 岁为老年组，≤65 岁为年轻组）将女性分为两组。采用单因素和多因素分析确定影响无病生存和总生存的因素。
共纳入 48 例老年（44.4%）和 60 例年轻（55.6%）女性。两组的手术时间、失血量、输血需求、淋巴结计数以及术中及术后并发症均无显著差异。老年组的癌症分期较年轻组更为晚期（17 [35.4%] 例比 8 [13.3%] 例，P = 0.01）。老年组和年轻组的 2 年和 5 年无病生存率分别为 82%和 96%（P = 0.003）和 74%和 93%（P = 0.0005），总 2 年和 5 年生存率分别为 87%和 98%（P = 0.006）和 83%和 95%（P = 0.01）。多因素分析显示，高级别手术分期、不良组织学类型、高级别肿瘤（G3）和深层肌层浸润（>50%）是复发的独立危险因素。
在不存在绝对麻醉禁忌的情况下，腹腔镜手术似乎对老年子宫内膜癌患者是可行且安全的。无论年龄大小，均应进行全面的手术分期，以避免分期不足，并优化治疗策略。
