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Is Robotic-Assisted Surgery Safe in the Elderly Population? An Analysis of Gynecologic Procedures in Patients ≥ 65 Years Old

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The elderly population is expanding worldwide but is underrepresented in clinical trials. We sought to assess the safety of robotic gynecologic surgery in an elderly cohort and to identify factors associated with unfavorable outcomes.

Methods

All patients ≥ 65 years who underwent a robotically assisted procedure at a single institution between May 2007 to December 2016 were divided into three age groups: 65–74 (Group 1); 75–84 (Group 2); ≥ 85 (Group 3). Perioperative outcomes were recorded in patients who did not require conversion to laparotomy. We compared clinical variables among groups and performed multivariate logistic regression to detect variables associated with major complications (≥ Grade 3) or 90-day mortality.

Results

We retrospectively identified 982 cases: 685 in Group 1; 249 in Group 2; 48 in Group 3. Median age = 71 years. Median BMI = 28.9. Malignancy was documented in 72.8% of cases; the majority were endometrial cancer (61.8%). Thirty-four patients (3.5%) were readmitted within 30 days. Seventy-seven (7.8%) had a postoperative complication, and 23 (2.3%) had a major complication. Ninety-day mortality was 0.5%. There was significant difference between groups with respect to body mass index (P = 0.026), ECOG PS (P ≤ 0.001), > 5 comorbidities (P = 0.005), hospital stay (P < 0.001), major complications (P = 0.001), and 90-day mortality (P < 0.001). On multivariable logistic regression, age ≥ 85 years was associated with major complications. Body mass index, age ≥ 85 years, and major complications were significantly associated with 90-day mortality.

Conclusions

Robotic-assisted surgery appears to be safe in an elderly cohort. The incidence of overall and major complications is consistent with those reported in the literature. Patients ≥ 85 years old appear to be at higher risk of unfavorable outcomes.

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Funding

This study was funded in part through the NIH/NCI Support Grant P30 CA008748.

Author information

Author notes

  1. Richard R. Barakat MD

    Present address: Northwell Health Cancer Institute, New Hyde Park, NY, USA

  2. Richard R. Barakat MD

    Present address: Zucker School of Medicine at Hofstra University, Hempstead, NY, USA

Authors and Affiliations

  1. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Alessia Aloisi MD, Jill H. Tseng MD, Samith Sandadi MD, Ryan Callery MD, Ginger J. Gardner MD, Yukio Sonoda MD, Carol L. Brown MD, Elizabeth L. Jewell MD, Richard R. Barakat MD & Mario M. Leitao Jr. MD

  2. Yale School of Medicine, New Haven, CT, USA

    Jacqueline Feinberg MD

  3. Rutgers New Jersey Medical School, Newark, NJ, USA

    Theresa Kuhn MD

  4. Weill Cornell Medical College, New York, NY, USA

    Ginger J. Gardner MD, Yukio Sonoda MD, Carol L. Brown MD, Elizabeth L. Jewell MD & Mario M. Leitao Jr. MD

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  1. Alessia Aloisi MD
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Corresponding author

Correspondence to Mario M. Leitao Jr. MD.

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Disclosures

The authors declare no conflicts of interest. Dr. Leitao does ad hoc consulting with Intuitive Surgical, Inc.

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Aloisi, A., Tseng, J.H., Sandadi, S. et al. Is Robotic-Assisted Surgery Safe in the Elderly Population? An Analysis of Gynecologic Procedures in Patients ≥ 65 Years Old. Ann Surg Oncol 26, 244–251 (2019). https://doi.org/10.1245/s10434-018-6997-1

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  • DOI: https://doi.org/10.1245/s10434-018-6997-1

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