Uccella Stefano, Bonzini Matteo, Palomba Stefano, Fanfani Francesco, Malzoni Mario, Ceccaroni Marcello, Seracchioli Renato, Ferrero Annamaria, Berretta Roberto, Vizza Enrico, Sturla Davide, Roviglione Giovanni, Monterossi Giorgia, Casadio Paolo, Volpi Eugenio, Mautone Daniele, Corrado Giacomo, Bruni Francesco, Scambia Giovanni, Ghezzi Fabio
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Epidemiology and Preventive Medicine Research Centre, Insubria University, Varese, Italy.
Gynecol Oncol. 2016 May;141(2):211-217. doi: 10.1016/j.ygyno.2016.02.029. Epub 2016 Feb 28.
Objective To investigate in depth the effect of increasing age on the peri-operative outcomes of laparoscopic treatment for endometrial cancer, compared to open surgery, with stratification of patients according to the different definitions of elderly age used in the literature.
Data of consecutive patients who underwent surgery for endometrial cancer staging at six centers were reviewed and analyzed according to surgical approach (laparoscopic or open), different definitions of elderly and very elderly age (≥65years, ≥75years, ≥80years), and class of age (<65; ≥65-<75; ≥75-80; ≥80years). Multivariable analysis to correct for possible confounders and propensity-score matching to minimize selection bias were used.
A total of 1606 patients were included: 938 and 668 patients received laparoscopic and open surgery, respectively. With increasing age, fewer patients received laparoscopy (P<0.001 with ANOVA). The percentage of patients who received lymphadenectomy declined significantly in both groups for age ≥80years. Blood transfusions, incidence and severity of post-operative complications, and hospital stay were significantly lower among patients who had laparoscopy both in younger (<65years) and elderly (whether defined as ≥65 or ≥75years) patients, with no effect of age on any of the characteristics analyzed (
P>0.05). The same tendency was observed among very-elderly patients (≥80years). Multivariable and propensity score-matched analysis confirmed these findings.
Laparoscopy for staging endometrial cancer retains its advantages over open surgery even in elderly and very-elderly patients. Our data strongly suggest that minimally-invasive surgery is advantageous even among subjects ≥80years.
目的 深入研究与开放手术相比，年龄增长对子宫内膜癌腹腔镜治疗围手术期结局的影响，并根据文献中使用的不同老年年龄定义对患者进行分层。
回顾并分析了六个中心接受子宫内膜癌分期手术的连续患者的数据，根据手术方式（腹腔镜或开放）、老年和高龄的不同定义（≥65岁、≥75岁、≥80岁）以及年龄组（<65岁；≥65 - <75岁；≥75 - 80岁；≥80岁）进行分析。采用多变量分析校正可能的混杂因素，并使用倾向得分匹配以尽量减少选择偏倚。
共纳入1606例患者：938例和668例患者分别接受了腹腔镜手术和开放手术。随着年龄的增加，接受腹腔镜检查的患者越来越少（方差分析P<0.001）。对于年龄≥80岁的患者，两组接受淋巴结清扫术的患者百分比均显著下降。在年轻（<65岁）和老年（定义为≥65岁或≥75岁）患者中，接受腹腔镜手术的患者输血、术后并发症的发生率和严重程度以及住院时间均显著较低，年龄对所分析的任何特征均无影响（方差分析：P>0.05）。在高龄患者（≥80岁）中也观察到相同的趋势。多变量和倾向得分匹配分析证实了这些发现。
即使在老年和高龄患者中，腹腔镜分期子宫内膜癌仍比开放手术具有优势。我们的数据强烈表明，即使在≥80岁的患者中，微创手术也是有利的。
