Surgery may benefit elderly women with endometrial cancer

NATIONAL HARBOR, MD. – Surgery is a safe option for elderly women who have endometrial cancer, significantly extending life with a low rate of surgical complications, findings from a small study showed.

A review of 68 women aged 75-94 years found that those who underwent surgery lived about 2 years longer than those who didn’t, Dr. Eloise Chapman-Davis reported at a meeting sponsored by the AAGL.

"Age, multiple comorbidities, high-risk endometrial histology, and stage alone should not exclude elderly patients from surgical treatment options," said Dr. Chapman-Davis, a gynecologic oncologist at Tufts Medical Center, Boston. "Survival may be improved in patients with endometrial cancer who undergo surgery as a part of their treatment."

The women in the current study were treated for endometrial cancer from 2005 to 2012. The first analysis broke the cohort down into those who had surgery (55) and those who did not. Significantly more women in the surgery group were younger than 80 years (85% vs. 45% of the nonsurgery group).

Stage 3 cancer was present in 16% of the surgical group and in 8% of the nonsurgical group. Stage 4 cancer was present in 3% of the surgical group and 31% of the nonsurgical group.

There were no significant differences in baseline comorbidities, including hypertension, diabetes, and pulmonary and coronary artery disease.

Every woman in the nonsurgical group underwent chemotherapy and 46% had radiation. In the surgical group, 20% had radiation and 20%, chemotherapy.

Surgical management changed over the course of the study. The facility implemented robotic surgery in 2009; after 2011, only one patient had laparotomy. The oldest patient who underwent open surgery was 87 years; the oldest patient who had robotic surgery was 94 years.

The surgical group was divided into those who had open (36) and robotic hysterectomies (19). Node sampling was significantly greater in the open group for both pelvic (83% vs. 53%) and aortic nodes (61% vs. 5%).

Robotic surgery took significantly longer than open surgery (mean, 196 vs. 137 minutes). However, blood loss was significantly less in the robotic surgery group (113 vs. 287 mL). Four patients in the open group needed more than 2 U of blood, and one patient lost more than 1,000 mL of blood.

In the robotic group, there was one conversion to open surgery, one cardiac event, and one ileus. In the open group, there were six cardiac events and six cases of prolonged ileus. The mean length of stay was 2 days in the robotic group and 6 days in the open group – a significant difference.

Age did not significantly affect survival. By 3.5 years, 60% of those up to age 79 years and 60% of those 80 and older were still living. Treatment, however, did exert a significant effect. The mean survival of patients who had no surgery was 3 years, compared with about 4 years for those who did have surgery.

The study did not address any survival differences between open and robotic procedures.

Dr. Chapman-Davis said she had no relevant financial disclosures.

[email protected]

NATIONAL HARBOR, MD. – Surgery is a safe option for elderly women who have endometrial cancer, significantly extending life with a low rate of surgical complications, findings from a small study showed.

A review of 68 women aged 75-94 years found that those who underwent surgery lived about 2 years longer than those who didn’t, Dr. Eloise Chapman-Davis reported at a meeting sponsored by the AAGL.

"Age, multiple comorbidities, high-risk endometrial histology, and stage alone should not exclude elderly patients from surgical treatment options," said Dr. Chapman-Davis, a gynecologic oncologist at Tufts Medical Center, Boston. "Survival may be improved in patients with endometrial cancer who undergo surgery as a part of their treatment."

The women in the current study were treated for endometrial cancer from 2005 to 2012. The first analysis broke the cohort down into those who had surgery (55) and those who did not. Significantly more women in the surgery group were younger than 80 years (85% vs. 45% of the nonsurgery group).

Stage 3 cancer was present in 16% of the surgical group and in 8% of the nonsurgical group. Stage 4 cancer was present in 3% of the surgical group and 31% of the nonsurgical group.

There were no significant differences in baseline comorbidities, including hypertension, diabetes, and pulmonary and coronary artery disease.

Every woman in the nonsurgical group underwent chemotherapy and 46% had radiation. In the surgical group, 20% had radiation and 20%, chemotherapy.

Surgical management changed over the course of the study. The facility implemented robotic surgery in 2009; after 2011, only one patient had laparotomy. The oldest patient who underwent open surgery was 87 years; the oldest patient who had robotic surgery was 94 years.

The surgical group was divided into those who had open (36) and robotic hysterectomies (19). Node sampling was significantly greater in the open group for both pelvic (83% vs. 53%) and aortic nodes (61% vs. 5%).

Robotic surgery took significantly longer than open surgery (mean, 196 vs. 137 minutes). However, blood loss was significantly less in the robotic surgery group (113 vs. 287 mL). Four patients in the open group needed more than 2 U of blood, and one patient lost more than 1,000 mL of blood.

In the robotic group, there was one conversion to open surgery, one cardiac event, and one ileus. In the open group, there were six cardiac events and six cases of prolonged ileus. The mean length of stay was 2 days in the robotic group and 6 days in the open group – a significant difference.

Age did not significantly affect survival. By 3.5 years, 60% of those up to age 79 years and 60% of those 80 and older were still living. Treatment, however, did exert a significant effect. The mean survival of patients who had no surgery was 3 years, compared with about 4 years for those who did have surgery.

The study did not address any survival differences between open and robotic procedures.

Dr. Chapman-Davis said she had no relevant financial disclosures.

[email protected]

NATIONAL HARBOR, MD. – Surgery is a safe option for elderly women who have endometrial cancer, significantly extending life with a low rate of surgical complications, findings from a small study showed.

A review of 68 women aged 75-94 years found that those who underwent surgery lived about 2 years longer than those who didn’t, Dr. Eloise Chapman-Davis reported at a meeting sponsored by the AAGL.

"Age, multiple comorbidities, high-risk endometrial histology, and stage alone should not exclude elderly patients from surgical treatment options," said Dr. Chapman-Davis, a gynecologic oncologist at Tufts Medical Center, Boston. "Survival may be improved in patients with endometrial cancer who undergo surgery as a part of their treatment."

The women in the current study were treated for endometrial cancer from 2005 to 2012. The first analysis broke the cohort down into those who had surgery (55) and those who did not. Significantly more women in the surgery group were younger than 80 years (85% vs. 45% of the nonsurgery group).

Stage 3 cancer was present in 16% of the surgical group and in 8% of the nonsurgical group. Stage 4 cancer was present in 3% of the surgical group and 31% of the nonsurgical group.

There were no significant differences in baseline comorbidities, including hypertension, diabetes, and pulmonary and coronary artery disease.

Every woman in the nonsurgical group underwent chemotherapy and 46% had radiation. In the surgical group, 20% had radiation and 20%, chemotherapy.

Surgical management changed over the course of the study. The facility implemented robotic surgery in 2009; after 2011, only one patient had laparotomy. The oldest patient who underwent open surgery was 87 years; the oldest patient who had robotic surgery was 94 years.

The surgical group was divided into those who had open (36) and robotic hysterectomies (19). Node sampling was significantly greater in the open group for both pelvic (83% vs. 53%) and aortic nodes (61% vs. 5%).

Robotic surgery took significantly longer than open surgery (mean, 196 vs. 137 minutes). However, blood loss was significantly less in the robotic surgery group (113 vs. 287 mL). Four patients in the open group needed more than 2 U of blood, and one patient lost more than 1,000 mL of blood.

In the robotic group, there was one conversion to open surgery, one cardiac event, and one ileus. In the open group, there were six cardiac events and six cases of prolonged ileus. The mean length of stay was 2 days in the robotic group and 6 days in the open group – a significant difference.

Age did not significantly affect survival. By 3.5 years, 60% of those up to age 79 years and 60% of those 80 and older were still living. Treatment, however, did exert a significant effect. The mean survival of patients who had no surgery was 3 years, compared with about 4 years for those who did have surgery.

The study did not address any survival differences between open and robotic procedures.

Dr. Chapman-Davis said she had no relevant financial disclosures.

[email protected]