Surgical Management of Early-Stage Endometrial Cancer in the Elderly: Is Laparoscopy Feasible?

Is endometrial carcinoma intrinsically more aggressive in elderly patients?

“…27 Recent data have suggested that laparoscopic staging in elderly patients with gynecologic malignancies appears to be well tolerated. 28 Perhaps the use of laparoscopy as a staging tool to better direct subsequent therapies instead of laparotomy might be useful in this group of patients. Whether pelvic EBRT is superior to IVRT in elderly patients with early-stage endometrial carcinoma could not be determined accurately from this retrospective study because EBRT generally was given to those patients with deep invasion or those with cervical involvement.…”

New Approaches to Hysterectomy by Minimal Invasive Surgery (MIS)

“…The rate of conversion to laparotomy has been reported between 3% to 16%, 36,37,38 . Older women had lower risk of surgical complications with laparoscopic vaginal approach 43,44 yet implementation of laparoscopic surgery in these patients is low. In a prospective study Vakin et al showed that using robotic assisted technique in elderly patients with endometrial cancer had similar overall outcomes when compared with younger patients with endometrial cancer, despite having significantly more co-morbidities and more advanced disease 38 .…”

The Modern Surgical Strategy for Endometrial Cancer: Laparoscopic Surgery

“…Many retrospective studies [13][14][15][16][17][18][19][20][21][22][23][24][25], prospective nonrandomized studies [26][27][28][29], and meta-analyses [49•, 50-52, 53•] published during the last decade have suggested that laparoscopic surgery has an improved outcomes profile in terms of estimated blood loss and transfusion requirements, recovery of bowel movement, postoperative hospital stay, and perioperative complications compared with laparotomy in the surgical management of endometrial cancer. These findings have been confirmed in recent RCTs comparing laparoscopy and laparotomy for surgical staging of endometrial cancer (Table 1) The following discussion of outcomes and complications of laparoscopic surgery compared with laparotomy is based on the results of the eight RCTs presented in Table 1.…”

“…Retrospective [13][14][15][16][17][18][19][20][21][22][23][24][25] or prospective, nonrandomized studies [26][27][28][29] have shown comparable survival outcomes for laparoscopic surgery and laparotomy. Four RCTs reported the long-term survival outcomes after laparoscopic surgery compared with laparotomy in patients with endometrial cancer (Table 1) [33, 35, 36, 45••].…”

“…Indeed, whilst endometrial cancer is the first gynecologic cancer to be treated laparoscopically, a laparoscopic approach also is being used for the surgical management of malignant disease. Following the first report on the use of laparoscopic surgery for endometrial cancer by Childers et al [12], the feasibility, safety, and efficacy of laparoscopic surgery in the surgical management of endometrial cancer has been reported in numerous retrospective studies [13][14][15][16][17][18][19][20][21][22][23][24][25], prospective nonrandomized studies [26][27][28][29], or randomized, controlled trials (RCTs) [30][31][32][33][34][35][36][37][38][39][40][41][42]43 This review provides an update on the role of laparoscopic surgery for the surgical management of endometrial cancer with particular emphasis on feasibility, safety, and efficacy based on the results of randomized, controlled trials comparing laparoscopy and laparotomy for surgical staging of endometrial cancer.…”