Bourgin C, Lambaudie E, Houvenaeghel G, Foucher F, Levêque J, Lavoué V
Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France.
Comprehensive Cancer Centre, Department of Surgical Oncology, Institut Paoli Calmette, 223 Boulevard Ste Marguerite, 13009 Marseille, France.
Eur J Surg Oncol. 2017 Apr;43(4):703-709. doi: 10.1016/j.ejso.2016.10.022. Epub 2016 Nov 27.
This study aims to evaluate the different surgical approaches, perioperative morbidity and surgical staging according to age in patients with endometrial cancer.
Multicentre retrospective study. Cancer characteristics and perioperative data were collected for patients surgically treated for endometrial cancer. The patients were divided into 2 groups according to their age: younger or older than 75 years.
Surgery was performed on 270 women <75 years old and on 74 ≥ 75 years old. Minimally invasive surgery was performed less often in the elderly compared with their younger counterparts (58.2% vs. 74.8%; p = 0.006). Independently of the surgical approach, the rate of pelvic and para-aortic lymphadenectomy was lower in women older than 75 years old than their younger counterparts (52.7% vs. 74.8%; p < 0.001; 8.1% vs. 21.8%; p = 0.007 respectively). According to the guidelines, more frequent surgical understaging was seen in the elderly compared with the younger (37% vs. 15.2%; p = 0.002). In the comparison of complications for each surgical approach, there was no statistical difference in the ≥75-year-old age group in terms of intra- or postoperative complications between the laparotomy, laparoscopy or robotic surgery group. We found a shorter length of hospital stay for the women who underwent laparoscopy or robotic surgery compared with laparotomy (p < 0.0001).
Elderly women with endometrial cancer are often surgically understaged whereas there is no evidence of greater perioperative complications than for their younger counterparts. They should benefit from minimally invasive surgery and optimal surgical staging to the same extent as younger women.
本研究旨在评估子宫内膜癌患者根据年龄不同的手术方式、围手术期发病率及手术分期情况。
多中心回顾性研究。收集接受子宫内膜癌手术治疗患者的癌症特征及围手术期数据。根据年龄将患者分为两组：75岁以下或75岁及以上。
对270名75岁以下及74名75岁及以上女性进行了手术。与年轻患者相比，老年患者接受微创手术的频率较低（58.2%对74.8%；p = 0.006）。无论采用何种手术方式，75岁以上女性盆腔及腹主动脉旁淋巴结清扫率均低于年轻患者（分别为52.7%对74.8%；p < 0.001；8.1%对21.8%；p = 0.007）。根据指南，老年患者手术分期不足的情况比年轻患者更常见（37%对15.2%；p = 0.002）。在比较每种手术方式的并发症时，75岁及以上年龄组在开腹手术、腹腔镜手术或机器人手术组的术中或术后并发症方面无统计学差异。我们发现接受腹腔镜手术或机器人手术的女性住院时间比开腹手术的女性短（p < 0.0001）。
老年子宫内膜癌女性患者常存在手术分期不足的情况，而没有证据表明其围手术期并发症比年轻患者更多。她们应与年轻女性一样从微创手术及最佳手术分期中获益。
