Abordaje quirúrgico del cáncer de endometrio en pacientes mayores

Abstract

Objective To evaluate the feasibility of distinct approaches for the treatment of endometrial cancer and associated morbidity in patients over 65 years old. Material and methods We performed a retrospective descriptive study of 70 consecutive patients diagnosed with endometrial cancer from 1996 to 2006. All the patients were 65 years old or older. The surgical approach was classified in three groups: vaginal, laparoscopy and laparotomy. The following factors were analyzed: age, body mass index, previous surgery, type of surgery, perioperative complications, laparotomy rate, mean length of hospital stay, transfusion rate, FIGO stage, histological type, and recurrence and survival rates. Statistical analysis was performed using SPPS computer analysis. Results The mean age was 72.37 ± 0.68 years (65-88) and the mean body mass index was 32.96 (17.57-52), with no statistically significant differences. Ten patients (14.28%) had previous abdominal surgery and 48 (68.67%) had endometrial risk factors. Surgical access was vaginal in six patients (8.5%), laparoscopic in 35 (50%) and laparotomic in 29 (41.4%). Lymphadenectomy was feasible in 69% of laparotomic interventions and in 97.1% of laparoscopic procedures (conversion rate: 5.7%). The intraoperative complications rate was 8.6% and the postoperative complications rate was 28.57%, with no statistically significant differences. The mean length of hospital stay was 6.39 ± 0.53 days (2-33), 5 ± 1.29 (3-10) with the vaginal route, 5.32 ± 0.47 (2-14) with laparoscopy, and 7.93 ± 1.07 (3-33) with laparotomy; differences between the vaginal and laparoscopic routes were statistically significant ( P<.01). The transfusion rate was 12.9%. The survival rate was similar among the three surgical approaches. Conclusions The laparoscopic approach is a feasible technique, with a low complications rate and a similar survival rate to that of other approaches.