Introduction/Background Endometrial cancer is the most common gynaecological malignancy in the developed world. Robot-assisted surgery has proven benefits particularly amongst the obese patients. Indeed older cohort fo patients could also benefit from this modality of surgery. The primary objective of this prospective study was to evaluate the risk factors for complications amongst older cohort of women. This could then help focus attention on specific elements of the peri-operative enhanced recovery pathway.
Methodology A multicentre prospective study amongst seven cancer centres in the United Kingdom was performed. The study was registered as a service evaluation at each of the individual centres and it was deemed that a formal ethical approval was not required. All women aged 65 or older, who were undergoing robot-assisted hysterectomy for early stage endometrial cancer were eligible. Frailty was evaluated using the Clinical Frailty Score. Post operative events including any unplanned readmissions were recorded. The cohort of patients who had not experienced any complications were compared with those that had any complications. Parametric, non-parametric and Chi-square tests were performed.
Results During this preliminary stage evaluation, dataset from119 patients were included. 106 experienced no complications and 13 (11%) were recorded as experiencing a complication ranging from Clavien-Dindo Grade I – IIIb. The median age of the entire cohort of patients was 74 years. There were no significant differences between the groups with respect to age, performance status, BMI, ASA or Charlson comorbidity index.Indeed there were no differences with respect to surgical procedure.Frailty (P<0.05) and polypharmacy (P<0.005) were significant risk factors.
Conclusion In this prospective evaluation of risk factors for post-operative complications in older women undergoing robot assisted surgery for endometrial cancer, frailty and polypharmacy are predictors of any complications. These two factors warrant special attention during the prehabilitation of older patients even prior to minimally invasive surgery.
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