Gynecologic oncologic surgery in the elderly: A retrospective analysis of 213 patients

Objectives. The aims of the study were (1) to analyze morbidity and mortali ty for elderly women (greater than or equal to 70 years) operated on for gy necological malignancies at our department between 1985 and 1996; and (2) t o compare two periods of time (years 1985-1990 versus years 1991-1996) to i nvestigate whether new expedients in the surgical technique as well as in t he perioperative management introduced by 1991 influenced the feasibility a nd tolerability of surgery in elderly patients. Methods. In a retrospective analysis, we evaluated tumor site, comorbiditie s, surgical features, morbility, and mortality. By 1991, several modificati ons in management were introduced, including: (1) early postoperative mobil ization; (2) self-donation with autologous blood transfusion; (3) intraoper ative antibiotic prophylaxis; (4) the retroperitoneum was left open and dra ins were not used after pelvic and aortic lymphadenectomy; (5) use of coagu lator forceps and hemoclips for meticolous hemostasis. Results. In 213 patients, tumor site distribution was uterine corpus n = 93 , ovary n = 51, vulva n = 29, cervix n = 23, breast 15, and vagina n = 2. T here were advanced stage diseases in 47%, comorbid illnesses in 76%, and hi gh surgical risk in 48%. Sixty-nine patients (group A) and 144 patients (gr oup B) were treated in the first and second study periods, respectively. Ov erall, severe postoperative morbidity and mortality were 17 and 2.8%, respe ctively. Group B compared to group A showed more frequent use of major surg ical procedures (P < 0.01) and lymphadenectomy (P < 0.04), lower transfusio n rate (P < 0.001), reduced severe morbidity (P < 0.002), lower mortality ( P = 0.3), and shorter hospital stay (P < 0.001), Conclusions. Our study suggests that surgery, including very radical proced ures, is reasonably feasible and well tolerated by elderly patients. The in troduction of technical and medical advances in the later years of the stud y resulted in a significant improvement of surgical rates. (C) 1999 Academi c Press.