Radical Hysterectomy and Age: Outcomes Comparison Based on a Minimally Invasive vs an Open Approach

Study Objective: To compare outcomes of radical hysterectomy (RH) across age groups based on surgical approach: minimally invasive surgery (MIS) vs laparotomy (LP). Design: Cross-sectional retrospective review (Canadian Task Force classification II-2). Setting: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M.D. Anderson Cancer Center. Patients: Patients with early-stage cervical cancer who underwent RH at a tertiary cancer center between 1990 and 2013. Interventions: Patients were stratified by age group (<50, 50–59, and ≥60 years) and by surgical approach (minimally invasive surgery [MIS] vs laparotomy [LP]). Measurements and Main Results: Patients with early-stage cervical cancer who underwent RH were retrospectively reviewed to obtain demographic data, surgical data, and clinical outcomes. We used the Fisher exact, Wilcoxon rank-sum, and Cochran–Mantel–Haenszel tests to compare categorical and continuous variables stratified by surgical approach and age group. A total of 548 patients were evaluated, including 427 (77.9%) who underwent LP (age <50, 84.3%; 50–59, 11.2%; ≥60, 4.5%) and 121 (22.1%) who underwent MIS (age <50, 71.9%; 50–59, 17.3%; ≥60, 10.8%). In the MIS group, 71 patients (58.7%) underwent laparoscopy and 50 (41.3%) underwent robotic surgery. Patients in the MIS group were significantly older and heavier than those in the LP group. The operative time was significantly longer in the MIS group. There was no between-group difference in intraoperative complications in any of the 3 age groups. LP patients had more infectious complications (respiratory, systemic, and wound) than MIS patients in the <50-year age group (53.3% vs 21.8%). The difference between the LP and MIS groups with respect to the postoperative noninfectious complication rate was greatest in the ≥60-year age group (p =.0324). Conclusion: The between-group difference in postoperative noninfectious complication rate in the oldest age group was twice that in either of the other 2 age groups (p =.0324), even though the MIS patients were older, heavier, and had a longer operative time compared with the LP patients.