PMID- 29037481
OWN - NLM
STAT- MEDLINE
DCOM- 20180125
LR  - 20190107
IS  - 1097-6868 (Electronic)
IS  - 0002-9378 (Linking)
VI  - 218
IP  - 1
DP  - 2018 Jan
TI  - Surgical outcomes among elderly women with endometrial cancer treated by
      laparoscopic hysterectomy: a NRG/Gynecologic Oncology Group study.
PG  - 109.e1-109.e11
LID - S0002-9378(17)31189-4 [pii]
LID - 10.1016/j.ajog.2017.09.026 [doi]
AB  - OBJECTIVE: Tolerance of and complications caused by minimally invasive
      hysterectomy and staging in the older endometrial cancer population is largely
      unknown despite the fact that this is the most rapidly growing age group in the
      United States. The objective of this retrospective review was to compare
      operative morbidity by age in patients on the Gynecologic Oncology Group
      Laparoscopic Surgery or Standard Surgery in Treating Patients With Endometrial
      Cancer or Cancer of the Uterus (LAP2) trial. STUDY DESIGN: This is a
      retrospective analysis of patients from Gynecologic Oncology Group LAP2, a trial 
      that included clinically early-stage uterine cancer patients randomized to
      laparotomy vs laparoscopy for surgical staging. Differences in the rates and
      types of intraoperative and perioperative complications were compared by age.
      Specifically complications between patients <60 vs >/=60 years old were compared 
      caused by toxicity analysis showing a sharp increase in toxicity starting at age 
      60 years in the laparotomy group. RESULTS: LAP2 included 1477 patients >/=60
      years old. As expected, with increasing age there was worsening performance
      status and disease characteristics including higher rates of serous histology,
      high-stage disease, and lymphovascular space invasion. There was no significant
      difference in lymph node dissection rate by age for the entire population or
      within the laparotomy or laparoscopy groups. Toxicity analysis showed a sharp
      increase in toxicity seen in patients >/=60 years old in the laparotomy group.
      Further analysis showed that when comparing laparotomy with laparoscopy in
      patients <60 years old vs >/=60 years old and controlling for race, body mass
      index, stage, grade, and performance status, patients <60 years old undergoing
      laparotomy had more hospital stays >2 days (odds ratio, 17.48; 95% confidence
      interval, 11.71-27.00, P < .001) compared with patients <60 years old undergoing 
      laparoscopy. However, when comparing laparotomy with laparoscopy in patients
      >/=60 years old, in addition to hospital stay >2 days (odds ratio, 12.77; 95%
      confidence interval, 8.74-19.32, P < .001), there were higher rates of the
      following postoperative complications: antibiotic administration (odds ratio,
      1.63; 95% confidence interval, 1.24-2.14, P < .001), ileus (odds ratio, 2.16; 95%
      confidence interval, 1.42-3.31, P <0.001), pneumonias (odds ratio, 2.36; 95%
      confidence interval, 1.01-5.66, P = .048), deep vein thromboses (odds ratio,
      2.87; 95% confidence interval, 1.08-8.03, P = .035), and arrhythmias (odds ratio,
      3.21; 95% confidence interval, 1.60-6.65, P = .001) in the laparotomy group.
      CONCLUSION: Laparoscopic staging for uterine cancer is associated with decreased 
      morbidity in the immediate postoperative period in patients >/=60 years old.
      These results allow for more accurate preoperative counseling. A minimally
      invasive approach to uterine cancer staging may decrease morbidity that could
      affect long-term survival.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Bishop, Erin A
AU  - Bishop EA
AD  - Department of Obstetrics and Gynecology, Section of Gynecologic Oncology,
      University of Oklahoma, Oklahoma City, OK. Electronic address: erbishop@mcw.edu.
FAU - Java, James J
AU  - Java JJ
AD  - NRG Oncology Statistics and Data Management Center, Roswell Park Cancer
      Institute, Buffalo, NY.
FAU - Moore, Kathleen N
AU  - Moore KN
AD  - Department of Obstetrics and Gynecology, Section of Gynecologic Oncology,
      University of Oklahoma, Oklahoma City, OK.
FAU - Spirtos, Nick M
AU  - Spirtos NM
AD  - Women's Cancer Center, Las Vegas, NV.
FAU - Pearl, Michael L
AU  - Pearl ML
AD  - Department of Gynecologic Oncology, Stony Brook University Hospital, Stony Brook,
      NY.
FAU - Zivanovic, Oliver
AU  - Zivanovic O
AD  - Division of Gynecologic Oncology, Memorial Sloan-Kettering Cancer Center, New
      York City, NY.
FAU - Kushner, David M
AU  - Kushner DM
AD  - Department of Gynecologic Oncology, University of Wisconsin-Madison, Madison, WI.
FAU - Backes, Floor
AU  - Backes F
AD  - Wexner Medical Center, Ohio State University, Hilliard, OH.
FAU - Hamilton, Chad A
AU  - Hamilton CA
AD  - Gynecologic Oncology Service, Walter Reed National Military Medical Center,
      Bethesda, MD.
FAU - Geller, Melissa A
AU  - Geller MA
AD  - University of Minnesota School of Medicine, Minneapolis, MN.
FAU - Hurteau, Jean
AU  - Hurteau J
AD  - Department of Obstetrics and Gynecology, Division of Gynecologic Oncology,
      University of Chicago Pritzker School of Medicine, NorthShore University Health
      System, Evanston, IL.
FAU - Mathews, Cara
AU  - Mathews C
AD  - Women and Infants Hospital, Providence, RI.
FAU - Wenham, Robert M
AU  - Wenham RM
AD  - Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research
      Institute, Tampa, FL.
FAU - Ramirez, Pedro T
AU  - Ramirez PT
AD  - Department of Gynecologic Oncology, M. D. Anderson Cancer Center, Houston, TX.
FAU - Zweizig, Susan
AU  - Zweizig S
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      University of Massachusetts Medical School, Worcester, MA.
FAU - Walker, Joan L
AU  - Walker JL
AD  - Department of Obstetrics and Gynecology, Section of Gynecologic Oncology,
      University of Oklahoma, Oklahoma City, OK.
LA  - eng
SI  - ClinicalTrials.gov/NCT00002706
GR  - U10 CA180868/CA/NCI NIH HHS/United States
GR  - U10 CA027469/CA/NCI NIH HHS/United States
GR  - U10 CA180850/CA/NCI NIH HHS/United States
GR  - U10 CA180798/CA/NCI NIH HHS/United States
GR  - U10 CA037517/CA/NCI NIH HHS/United States
GR  - P30 CA016058/CA/NCI NIH HHS/United States
GR  - U10 CA180822/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20171014
PL  - United States
TA  - Am J Obstet Gynecol
JT  - American journal of obstetrics and gynecology
JID - 0370476
RN  - 0 (Anti-Bacterial Agents)
SB  - AIM
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Arrhythmias, Cardiac/epidemiology
MH  - Carcinoma, Endometrioid/pathology/surgery
MH  - Endometrial Neoplasms/pathology/*surgery
MH  - Female
MH  - Humans
MH  - *Hysterectomy
MH  - Ileus/epidemiology
MH  - Intraoperative Complications
MH  - *Laparoscopy
MH  - Laparotomy
MH  - Length of Stay/statistics & numerical data
MH  - Middle Aged
MH  - Neoplasm Invasiveness
MH  - Pneumonia/epidemiology
MH  - Postoperative Complications
MH  - Retrospective Studies
MH  - Venous Thrombosis/epidemiology
PMC - PMC5756682
MID - NIHMS913047
OTO - NOTNLM
OT  - *LAP2
OT  - *endometrial
OT  - *older
EDAT- 2017/10/19 06:00
MHDA- 2018/01/26 06:00
CRDT- 2017/10/18 06:00
PHST- 2017/06/29 00:00 [received]
PHST- 2017/09/21 00:00 [revised]
PHST- 2017/09/29 00:00 [accepted]
PHST- 2017/10/19 06:00 [pubmed]
PHST- 2018/01/26 06:00 [medline]
PHST- 2017/10/18 06:00 [entrez]
AID - S0002-9378(17)31189-4 [pii]
AID - 10.1016/j.ajog.2017.09.026 [doi]
PST - ppublish
SO  - Am J Obstet Gynecol. 2018 Jan;218(1):109.e1-109.e11. doi:
      10.1016/j.ajog.2017.09.026. Epub 2017 Oct 14.