Bogani Giorgio, Raspagliesi Francesco, Malzoni Mario, Cuccu Ilaria, Vizzielli Giuseppe, Scambia Giovanni, Ghezzi Fabio, Casarin Jvan
Gynecologic Oncologic Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Department of Gynecological, Obstetrical and Urological Sciences, 'Sapienza' University of Rome, Rome, Italy.
Gynecologic Oncologic Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
Eur J Surg Oncol. 2025 Mar;51(3):109568. doi: 10.1016/j.ejso.2024.109568. Epub 2024 Dec 27.
To assess the safety and long-term effectiveness of minimally invasive approach in managing "oldest old" endometrial cancer patients.
This is a retrospective cohort, multi-institutional study. Consecutive patients, treated between 2000 and 2020, with apparent early-stage endometrial cancer patients, aged ≥85 years. Surgery-related outcomes of robotic-assisted, laparoscopic, and vaginal surgery were compared. Survival was evaluated in patients with at least 3-year follow-up data.
Charts of 82 endometrial cancer patients "oldest old" were retrieved. Intermediate-high and high-risk endometrial cancer patients accounted for 26 (31.7 %) and 17 (20.7 %), respectively. In total, 12 (15 %), 45 (55 %), and 25 (30 %) patients underwent robotic-assisted, laparoscopic, and vaginal surgery, respectively. Looking at surgery-related outcomes, robotic-assisted surgery correlated with a longer operative time (p < 0.001) and longer length of hospital stay (p = 0.002) in comparison to laparoscopic and vaginal approaches. Overall, seven (8.5 %) conversions from the planned approach occurred. The surgical approach did not influence disease-free survival (p = 0.6061) and overall survival (p = 0.4950). Via multivariate analysis, only serosal/adnexal invasion correlated with the risk of death (HR: 3.752, p = 0.038).
All three minimally invasive approaches are safe and effective methods for managing endometrial cancer in the oldest old population. Chronological age, per se, should not be considered a contraindication for receiving minimally invasive surgery.
评估微创方法治疗“超高龄”子宫内膜癌患者的安全性和长期有效性。
这是一项回顾性队列多机构研究。纳入2000年至2020年间连续治疗的年龄≥85岁的早期子宫内膜癌患者。比较机器人辅助手术、腹腔镜手术和阴道手术的手术相关结局。对至少有3年随访数据的患者进行生存评估。
检索到82例“超高龄”子宫内膜癌患者的病历。中高危和高危子宫内膜癌患者分别占26例（31.7%）和17例（20.7%）。分别有12例（15%）、45例（55%）和25例（30%）患者接受了机器人辅助手术、腹腔镜手术和阴道手术。从手术相关结局来看，与腹腔镜和阴道手术相比，机器人辅助手术的手术时间更长（p<0.001），住院时间更长（p=0.002）。总体而言，7例（8.5%）发生了计划手术方式的转换。手术方式不影响无病生存期（p=0.6061）和总生存期（p=0.4950）。通过多因素分析，只有浆膜/附件侵犯与死亡风险相关（HR：3.752，p=0.038）。
所有三种微创方法都是治疗超高龄人群子宫内膜癌的安全有效方法。年龄本身不应被视为接受微创手术的禁忌证。
