ABSTRACT
INTRODUCTION: Older patients (OP) diagnosed with endometrial cancer (EC) are less likely to receive an optimal surgical treatment compared with non-older patients (NOP). This undertreatment along with the presence of more aggressive tumours at diagnosis can explain the worse prognosis of EC in OP. There is limited evidence comparing perioperative outcomes between OP and NOP, and the benefit of applying complex procedures to OP is still controversial. The primary objective of the study was to compare intraoperative and postoperative complications between NOP and OP with EC that underwent primary surgery. Secondary objectives were to compare surgical management and survival rates. METHODS: This is a retrospective single-centre observational study including women undergoing surgery for EC between 2010 and 2019. Patients were classified according to age as NOP (younger than 75 years) or OP (75 years or older). Basal characteristics and surgical outcomes of groups were compared using Chi-square, Fisher's exact tests, student T-tests or Mann Whitney tests. Kaplan Meier analysis was used to evaluate survival. RESULTS: In total 281 patients underwent primary surgery for EC between 2010 and 2019 in our centre. At diagnosis, 184 patients were younger than 75 years while 97 were 75 and older. No differences were found in disease characteristics. Most of our patients (83,3%) underwent laparoscopic surgery. Pelvic (58,2% vs. 37,1%, p = 0,001) and para-aortic (46,7% vs. 23,7%, p < 0,001) lymphadenectomies were performed more frequently in NOP compared with OP. Rates of intra-operative (6,5% vs. 12,4%, p = 0,116) and post-operative (13,0% vs. 20,6%, p = 0,120) complications were not statistically different between NOP and OP, and neither was the rate of severe complications according to Clavien-Dindo classification (5,4% vs. 8,2% of complications grade III-V respectively, p = 0,387). The 5-year disease-specific survival (DSS) rate tended to be lower in the OP than in the NOP (74,8% vs. 82,5%, p = 0,071). Considering only patients in whom complete surgical staging was performed, OP presented similar DSS to NOP, with comparable complication rate. CONCLUSIONS: OP do not present a significantly higher rate of perioperative complications compared to NOP. However, they underwent fewer lymphadenectomies and tended to present poorer DSS. Further studies are needed to standardize the surgical management of these patients.
Subject(s)
Endometrial Neoplasms , Laparoscopy , Aged , Endometrial Neoplasms/pathology , Female , Humans , Laparoscopy/adverse effects , Lymph Node Excision/methods , Postoperative Complications/etiology , Retrospective StudiesABSTRACT
El abordaje de los miomas uterinos sintomáticos ha presentado una franca evolución en los últimos años gracias a la aparición de técnicas mínimamente invasivas que permiten la conservación uterina. La embolización selectiva de arterias uterinas (EAU) consiste en la oclusión completa de las 2 arterias uterinas con partículas embolizantes con el objetivo de producir una necrosis isquémica de los miomas sin afectar de forma permanente al tejido uterino normal. Esta técnica mejora significativamente la cantidad de sangrado y produce una reducción del volumen uterino a los 3 meses posprocedimiento, que se mantiene a lo largo del tiempo, permitiendo que un 70% de las pacientes evite la cirugía. Por otro lado, la EAU conlleva un menor tiempo quirúrgico, una reducción en la estancia hospitalaria y un menor número de días necesarios para la reincorporación a la vida laboral si lo comparamos con las técnicas quirúrgicas clásicas (histerectomía y miomectomía), sin presentar diferencias en las escalas de calidad de vida a 5 años. Por lo tanto creemos que debe incluirse la EAU en las opciones terapéuticas que ofrecer a las pacientes con útero miomatoso sintomático (AU)
The approach to symptomatic uterine fibroids has seen a marked evolution in recent years thanks to the emergence of minimally invasive techniques that allow for uterine preservation. Selective uterine artery embolization (UAE) consists of the complete occlusion of the 2 uterine arteries with embolic particles in order to produce ischemic necrosis of the fibroids without permanently affecting the normal uterine tissue. This technique significantly reduces the amount of bleeding and causes a reduction in uterine volume at 3 months postprocedure, which is maintained over time, allowing for 70% of patients to avoid surgery. Moreover, UAE entails shorter surgical times, reduced hospital stays and fewer days needed to return to work when compared with traditional surgical techniques (hysterectomy and fibroidectomy), without any differences in the quality-of-life scales at 5 years. UAE should therefore be included in the therapeutic options offered to patients with symptomatic fibroid uteri (AU)
