Safety and tolerance of radical hysterectomy for cervical cancer in the elderly

Background Despite institutional studies that suggest that radical hysterectomy for cervical cancer is well tolerated in the elderly, little population-level data are available on the procedure's outcomes in older women. We performed a population-based analysis to determine the morbidity, mortality, and resource utilization of radical hysterectomy in elderly women with cervical cancer. Methods Patients recorded in the Nationwide Inpatient Sample with invasive cervical cancer who underwent abdominal radical hysterectomy between 1998and 2010 were analyzed. Patients were stratified by age: < 50, 50-59, 60-69, and ≥ 70 years. We examined the association between age and the outcomes of interest using chi square tests and multivariable generalized estimating equations. Results A total of 8199 women were identified, including 768 (9.4%) women age 60-69 and 462 (5.6%) women ≥ 70 years of age. All cause morbidity increased from 22.1% in women < 50, to 24.7% in those 50-59 years, 31.4% in patients 60-69 years and 34.9% in women > 70 years of age (P < 0.0001). Compared to women < 50, those > 70 were more likely to have intraoperative complications (4.8% vs. 9.1%, P = 0.0003), surgical site complications (10.9% vs. 17.5%, P < 0.0001), and medical complications (9.9% vs. 19.5%, P < 0.0001). The risk of non-routine discharge (to a nursing facility) was 0.5% in women < 50 vs. 12.3% in women ≥ 70 (P < 0.0001). Perioperative mortality women ≥ 70 years of age was 30 times greater than that of women < 50 (P < 0.0001). Conclusion Perioperative morbidity and mortality are substantially greater in elderly women who undergo radical hysterectomy for cervical cancer. Non-surgical treatments should be considered in these patients.