Robotic Surgery in Elderly and Very Elderly Gynecologic Cancer Patients

Valerio Gallotta, Carmine Conte, Marco D'Indinosante, Alex Federico, Antonella Biscione, Giuseppe Vizzielli, Carolina Bottoni, Maria Vittoria Carbone, Francesco Legge, Stefano Uccella, Pierpaolo Ciocchetti, Andrea Russo, Lorenzo Polidori, Giovanni Scambia, Gabriella Ferrandina

Research output: Contribution to journalArticle

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Abstract

Study Objective: To investigate the feasibility, safety, and short-term outcomes of robotic surgery (RS) for gynecologic oncologic indications (cervical, endometrial, and ovarian cancer) in elderly patients, especially women age 65 to 74 years (elderly group [EG]) compared with women age ≥75 years (very elderly group [VEG]). Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Catholic University of the Sacred Heart, Rome, Italy. Patients: Between May 2013 and April 2017, 204 elderly and very elderly patients underwent RS procedures for gynecologic malignancies. Results: The median age was 71 years (range, 65–74 years) in the EG and 77 years (range, 75–87 years) in the VEG. The incidence of cardiovascular disease was higher in the VEG (p =.038). The EG and VEG were comparable in terms of operative time, blood loss, and need for blood transfusion. Almost all (98.5%) of the patients underwent total/radical hysterectomy, 109 patients (55.6% of the EG vs 48.3% of the VEG) underwent pelvic lymphadenectomy, and 19 patients (10.5% of the EG vs 6.7% of the VEG) underwent aortic lymphadenectomy. A total of 7 (3.4%) conversions to open surgery were registered. Only 3 patients required postoperative intensive care unit admission. The median length of hospital stay was 2 days in each group. A total of 11 patients (5.6%) had early postoperative complications. Four patients (2.8%) in the EG and 2 patients (3.3%) in the VEG experienced grade ≥2 complications. At the time of analysis, median follow-up was 18 months (range, 6–55 months). Eleven patients (5.6%) experienced disease relapse, 2 (1%) died of disease, and 3 (1.5%) died of cardiovascular disease. Conclusions: This study demonstrates the feasibility, safety, and good short-term outcomes of RS in elderly and very elderly gynecologic cancer patients. No patient can be considered too old for a minimally invasive robotic approach, but a multidisciplinary approach is the best management pathway; efforts to reduce associated morbidity are essential.

Original languageEnglish
Pages (from-to)872-877
Number of pages6
JournalJournal of Minimally Invasive Gynecology
Volume25
Issue number5
DOIs
Publication statusPublished - Jul 1 2018

Fingerprint

Robotics
Neoplasms
Gynecologic Surgical Procedures
Lymph Node Excision
Length of Stay
Cardiovascular Diseases
Conversion to Open Surgery
Safety
Postoperative Care
Feasibility Studies
Advisory Committees
Endometrial Neoplasms
Operative Time
Hysterectomy

Keywords

  • Elderly patients
  • Gynecologic oncology
  • Robotic surgery

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Robotic Surgery in Elderly and Very Elderly Gynecologic Cancer Patients. / Gallotta, Valerio; Conte, Carmine; D'Indinosante, Marco; Federico, Alex; Biscione, Antonella; Vizzielli, Giuseppe; Bottoni, Carolina; Carbone, Maria Vittoria; Legge, Francesco; Uccella, Stefano; Ciocchetti, Pierpaolo; Russo, Andrea; Polidori, Lorenzo; Scambia, Giovanni; Ferrandina, Gabriella.

In: Journal of Minimally Invasive Gynecology, Vol. 25, No. 5, 01.07.2018, p. 872-877.

Research output: Contribution to journalArticle

Gallotta, V, Conte, C, D'Indinosante, M, Federico, A, Biscione, A, Vizzielli, G, Bottoni, C, Carbone, MV, Legge, F, Uccella, S, Ciocchetti, P, Russo, A, Polidori, L, Scambia, G & Ferrandina, G 2018, 'Robotic Surgery in Elderly and Very Elderly Gynecologic Cancer Patients', Journal of Minimally Invasive Gynecology, vol. 25, no. 5, pp. 872-877. https://doi.org/10.1016/j.jmig.2018.01.007
Gallotta, Valerio ; Conte, Carmine ; D'Indinosante, Marco ; Federico, Alex ; Biscione, Antonella ; Vizzielli, Giuseppe ; Bottoni, Carolina ; Carbone, Maria Vittoria ; Legge, Francesco ; Uccella, Stefano ; Ciocchetti, Pierpaolo ; Russo, Andrea ; Polidori, Lorenzo ; Scambia, Giovanni ; Ferrandina, Gabriella. / Robotic Surgery in Elderly and Very Elderly Gynecologic Cancer Patients. In: Journal of Minimally Invasive Gynecology. 2018 ; Vol. 25, No. 5. pp. 872-877.
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AU - D'Indinosante, Marco

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AU - Biscione, Antonella

AU - Vizzielli, Giuseppe

AU - Bottoni, Carolina

AU - Carbone, Maria Vittoria

AU - Legge, Francesco

AU - Uccella, Stefano

AU - Ciocchetti, Pierpaolo

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AU - Polidori, Lorenzo

AU - Scambia, Giovanni

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N2 - Study Objective: To investigate the feasibility, safety, and short-term outcomes of robotic surgery (RS) for gynecologic oncologic indications (cervical, endometrial, and ovarian cancer) in elderly patients, especially women age 65 to 74 years (elderly group [EG]) compared with women age ≥75 years (very elderly group [VEG]). Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Catholic University of the Sacred Heart, Rome, Italy. Patients: Between May 2013 and April 2017, 204 elderly and very elderly patients underwent RS procedures for gynecologic malignancies. Results: The median age was 71 years (range, 65–74 years) in the EG and 77 years (range, 75–87 years) in the VEG. The incidence of cardiovascular disease was higher in the VEG (p =.038). The EG and VEG were comparable in terms of operative time, blood loss, and need for blood transfusion. Almost all (98.5%) of the patients underwent total/radical hysterectomy, 109 patients (55.6% of the EG vs 48.3% of the VEG) underwent pelvic lymphadenectomy, and 19 patients (10.5% of the EG vs 6.7% of the VEG) underwent aortic lymphadenectomy. A total of 7 (3.4%) conversions to open surgery were registered. Only 3 patients required postoperative intensive care unit admission. The median length of hospital stay was 2 days in each group. A total of 11 patients (5.6%) had early postoperative complications. Four patients (2.8%) in the EG and 2 patients (3.3%) in the VEG experienced grade ≥2 complications. At the time of analysis, median follow-up was 18 months (range, 6–55 months). Eleven patients (5.6%) experienced disease relapse, 2 (1%) died of disease, and 3 (1.5%) died of cardiovascular disease. Conclusions: This study demonstrates the feasibility, safety, and good short-term outcomes of RS in elderly and very elderly gynecologic cancer patients. No patient can be considered too old for a minimally invasive robotic approach, but a multidisciplinary approach is the best management pathway; efforts to reduce associated morbidity are essential.

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