Oncologic outcomes in elderly patients who underwent hysterectomy for endometrial cancer: a multi-institutional survey in Kinki District, Japan.

Tanaka, Tomohito; Yamashita, Suguru; Kuroboshi, Haruo; Kamibayashi, Junya; Sugiura, Atsushi; Yoriki, Kaori; Mori, Taisuke; Tanaka, Kazuharu; Nagashima, Aiko; Maeda, Michihide; Kamiura, Shoji; Mizuno, Yukako; Ohtake, Noriko; Ichimura, Tomoyuki; Kikuchi, Taiki; Nobuta, Yuri; Amano, Tsukuru; Matsumura, Noriomi; Nakai, Hidekatsu; Kobayashi, Eiji

Background: The goal of this study is to assess the oncologic outcomes of elderly patients who underwent hysterectomy for endometrial cancer across three variables: hysterectomy approach, lymph node resection, and adjuvant therapy. Methods: Hospital records of patients aged ≥ 70 years who underwent hysterectomy for endometrial cancer were obtained from 19 institutions. Patients were categorized into three risk groups: low, intermediate, and high. In each group, disease-free survival and overall survival were compared according to hysterectomy approach, lymph node resection, and adjuvant therapy using Kaplan–Meier method. Cox regression analysis with a 95% confidence interval was performed to estimate relative risk (RR) of death. Results: A total of 1246 patients were included. In the low-risk group, the adjusted RR for death for minimally invasive surgery (MIS) versus laparotomy and lymph node resection versus no lymph node resection were 0.64 (0.24–1.72) and 0.52 (0.24–1.12), respectively. In the intermediate-risk group, the adjusted RR for death for MIS versus laparotomy, lymph node resection versus no lymph node resection, and adjuvant therapy versus no adjuvant therapy were 0.80 (0.36–1.77), 0.60 (0.37–0.98), and 0.89 (0.55–1.46), respectively. In the high-risk group, the adjusted RRs for death for lymph node resection versus no lymph node resection and adjuvant therapy versus no adjuvant therapy were 0.56 (0.37–0.86) and 0.60 (0.38–0.96), respectively. Conclusions: MIS is not inferior to laparotomy in uterine-confined diseases. Lymph node resection improved the outcome for all disease stages and histological types. In contrast, adjuvant therapy improved the outcomes only in high-risk patients.

JAPAN; OLDER patients; ENDOMETRIAL cancer; ENDOMETRIAL surgery; MINIMALLY invasive procedures; HYSTERECTOMY; LYMPH nodes

International Journal of Clinical Oncology, 2022, Vol 27, Issue 6, p1084

1341-9625

Academic Journal

10.1007/s10147-022-02152-6