Usefulness of Geriatric Parameters in Preoperative Evaluation of Patients Undergoing Minimally Invasive Surgery for Endometrial Cancer: A Retrospective Cohort Study.

Abstract

Patients operated for endometrial cancer (EMCA) are typically elderly with multiple comorbidities, potentially impacting surgical outcomes and survival. This study evaluated the prognostic value of frailty and frailty-related scores in predicting perioperative morbidity and survival in EMCA patients undergoing minimally invasive surgery. This retrospective cohort study included 289 patients from the Sentinel Database treated for EMCA at Bern University Hospital (2012-2020). Patients underwent minimally invasive hysterectomy with sentinel lymph node dissection (39%) or additional radical lymphadenectomy (61%). Frailty was assessed using the Age-Adjusted Charlson Comorbidity Index (ACCI), modified Frailty Index (mFI), 5-item mFI (mFI-5), American Society of Anesthesiologists (ASA) scores, and independent parameters. Primary outcomes included perioperative complications, hospital stay, recurrence-free survival (RFS), and overall survival (OS). Median age was 65 years (range 26-94) and median follow-up was 41 months (0-105). ACCI > 4 (23.2%) was the strongest predictor of postoperative complications (p = 0.025), prolonged hospitalization (p = 0.03), and reduced OS (hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.18-5.60; p = 0.018). Multivariable analysis confirmed ACCI > 4 (HR 2.24, 95% CI 1.02-4.90; p = 0.044), European Society for Medical Oncology (ESMO) risk group (HR 1.61, 95% CI 1.24-2.07; p < 0.001), hemoglobin (HR 1.03, 95% CI 1.00-1.05; p = 0.033), and congestive heart failure (HR 6.29, 95% CI 1.35-29.27; p =0.019) were significant predictors of OS. Radical lymphadenectomy (p < 0.001), ACCI > 4 (p = 0.025), and age > 70 years (p = 0.034) increased complication risks. ACCI > 4 is a practical tool for preoperative risk assessment and predicting surgical tolerance and survival, and is therefore applicable for guiding surgical decisions and personalized care in patients with EMCA.