Laparoscopic vs. open treatment of endometrial cancer in the elderly and very elderly: An age-stratified multicenter study on 1606 women

Objective To investigate in depth the effect of increasing age on the peri-operative outcomes of laparoscopic treatment for endometrial cancer, compared to open surgery, with stratification of patients according to the different definitions of elderly age used in the literature. Methods Data of consecutive patients who underwent surgery for endometrial cancer staging at six centers were reviewed and analyzed according to surgical approach (laparoscopic or open), different definitions of elderly and very elderly age (≥ 65 years, ≥ 75 years, ≥ 80 years), and class of age (< 65; ≥ 65- < 75; ≥ 75-80; ≥ 80 years). Multivariable analysis to correct for possible confounders and propensity-score matching to minimize selection bias were used. Results A total of 1606 patients were included: 938 and 668 patients received laparoscopic and open surgery, respectively. With increasing age, fewer patients received laparoscopy (P < 0.001 with ANOVA). The percentage of patients who received lymphadenectomy declined significantly in both groups for age ≥ 80 years. Blood transfusions, incidence and severity of post-operative complications, and hospital stay were significantly lower among patients who had laparoscopy both in younger (< 65 years) and elderly (whether defined as ≥ 65 or ≥ 75 years) patients, with no effect of age on any of the characteristics analyzed (ANOVA: P > 0.05). The same tendency was observed among very-elderly patients (≥ 80 years). Multivariable and propensity score-matched analysis confirmed these findings. Conclusions Laparoscopy for staging endometrial cancer retains its advantages over open surgery even in elderly and very-elderly patients. Our data strongly suggest that minimally-invasive surgery is advantageous even among subjects ≥ 80 years.