Hysterectomy for Uterine Cancer in the Elderly: A Comparison Between Laparoscopic and Robot-Assisted Techniques

The mainstay of treatment for uterine corpus cancer is surgical, and the gold standard approach has become minimally invasive surgery. The aim of this study is to compare the perioperative complications and demographics of patients 80 years old or more undergoing robotic and laparoscopic hysterectomy for uterine cancer.

Using the Nationwide Inpatient Sample, we retrospectively identified all women aged 80 years or older who had hysterectomies for uterine cancer by either modality. The complication rates of surgery in both groups were adjusted for potential confounding and compared using logistic regression analyses.

There were 915 women aged 80 years or older identified with uterine corpus cancer who had either laparoscopic or robotic surgery. Robotically treated patients were more likely to be obese (8.8% vs 3.5%) but were otherwise similar in terms of mean age, comorbidities, income, ethnicity, and insurance status. Those undergoing robotic surgery were less likely to have admissions beyond 3 days (29.0% vs 38.2%; adjusted odds ratio, 0.66; P < 0.01) and had a lower composite incidence of any complication (24.3% vs 31.6%; adjusted odds ratio, 0.7; P < 0.05). When looking at those who had lymph node dissections, there was a lower rate of postoperative ileus, and a trend toward fewer venous thromboembolic events.

Among octogenarians and nonagenarians with uterine corpus cancer, robotic surgery is associated with a shorter hospital admission and a better complication profile than laparoscopy.