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Abstract
Introduction/Background*Older patients (OP) usually present with more aggressive endometrial cancer (EC) at diagnosis. However, they often receive suboptimal surgical treatment compared with non-older patients (NOP). Undertreatment, along with the presence of more aggressive tumours can explain the worse prognosis of EC in OP.
There is limited evidence comparing perioperative outcomes between OP and NOP. The benefit of applying complex procedures to OP is still controverse. The goal of this study was to compare complications after surgical treatment of EC between NOP and OP.
Methodology This is a retrospective single-center observational study including women undergoing surgery for EC between 2010 and 2019. Patients were classified according to age as NOP (younger than 75 years) or OP (75 years or older). Basal characterisitcs of groups were compared using Chi-square, Fisher’s exact tests, student T-tests or Mann-Whithney tests. Kaplan Meier analysis was used to evaluate survival.
Result(s)*In total 283 patients were included, 185 were classified as NOP while 98 as OP. No differences were found in disease characteristics. Laparoscopy was performed in 82% of patients. Both pelvic and para-aortic lymphadenectomy were performed more frequently in NOP than in OP (56,8% vs. 36,7%; p<0,01 and 45,9 vs. 22,9%; p<0,01). Rates of intra-operative (6,5% vs 12,4%, p=0,12) and post-operative (13,5% vs 20,6% p=0,13) complications were similar between NOP and OP respectively, as well as the severity of complications according to Clavien-Dindo classification (4,4% vs 7,4% grade III, 0,5% vs 0% grade IV, p=0,51). No differences were found in other surgical and post-operative variables. The 5-year disease-specific survival (DSS) rate was lower in OP (66,9% vs 86,0%, p=0,02). When analyzing only patients who underwent complete staging surgery (107 of the NOP and 35 of the OP), no differences were found in perioperative complications rate. In this subgroup, there were no differences in DSS between NOP and OP (78,1% vs 71,0%, p=0,64).
Conclusion*OP do not present a higher rate of perioperative complications compared to NOP. However, they underwent less lymphadenectomies and presented poorer DSS. Considering only patients in whom complete surgery was performed, OP presented similar DSS to NOP, without presenting a higher rate of perioperative complications.