Feasibility of radical surgery in the management of elderly patients with uterine cervical cancer in Korea

Abstract

To evaluate the tolerance and the outcome of radical surgery in the management of elderly patients with uterine cervical cancer in Korea, seventy-seven patients with stage Ib or IIa squamous cell carcinoma of the uterine cervix, diagnosed at Seoul National University Hospital from January 1996 to June 2003, were retrospectively reviewed. Sixty-six patients undergoing radical surgery were divided into two groups according to their age: 41-50 years (group A; n = 43) and 65 years or older (group B; n = 23). Statistical analysis was conducted by using Mann-Whitney U test and Fisher's exact t test. Although group B consists of more stage IIa cases than group A (27.9 vs. 52.2%), the difference in the stage between both groups was statistically insignificant. Medical comorbidities in group B were higher than group A, primarily due to hypertension (23.3 vs. 56.5%, p = 0.014). Mean operation time, mean blood loss, perioperative transfusion, frequency of intraoperative injuries, duration of hospital stay, and postoperative complications were similar except 1 case of operation-related mortality in group B. The pathologist's report indicated a positive resection margin of the vagina in 6 cases of group B but none in group A. The difference in parametrial involvement, lymph node involvement, lymphovascular space invasion, deep cervical wall involvement and larger tumor with a diameter >4 cm was not significant. The number of patients who received adjuvant therapy was significantly higher in group B than group A (23.3 vs. 65.2%, p = 0.001). The recurrence rate, however, was not different. Our study suggests that radical surgery in the management of elderly patients with stage Ib or IIa uterine cervical cancer is reasonably feasible. Chronological age alone should not be considered a contraindication to radical hysterectomy.