Pre-operative geriatric screening and assessment as predictors of postoperative complications in elderly patients with gynecologic cancer: A pilot cohort study on a neglected issue

A BS T R A C T
Objectives: Ovarian and uterine malignancies in the elderly are a neglected issue in literature and preoperative assessment is often challenging for gynecologic oncologists. We aimed to investigate if Comprehensive Geriatric Assessment (CGA) is associated with major post-operative complications in this specific setting.
Methods: Patients 65 years or older with gynecologic cancers undergoing CGA before cytoreductive surgery were eligible. CGA scores, Geriatric 8 (G8), Performance Status (PS), American Society of Anesthesiologists (ASA) as well as Surgical Complexity Score (SCS) were evaluated for association with 30-day postoperative complications (POCs) Clavien-Dindo ≥ 2. Multivariate regression analyses were conducted.
Results: Grade 2 and grade 3 POCs developed in 10 and 6 patients (18.2% and 10.9%), hemorrhagic complications being the most common. R0 cytoreduction was completed in 83.6% cases, 20 and 5 surgeries were completed respectively with laparoscopic and robotic approach. Despite high prevalence of ASA3, most of patients were ADL and IADL independent, showed good physical and cognitive performance and had no severe comorbidities. Traditional variables (age, FIGO stage, PS, ASA, SCS) were not significantly associated with outcome. Only G8 ≤14 survived multivariate analysis as an independent predictor of complications.
Conclusions: If adequately selected, gynecologic cancer surgery in the elderly can be radical, safe and minimally invasive. Even if CGA didn’t show significative association with POCs, it offered a different and wider assessment than anesthesiologic evaluation. G8 could be a surgical complication predictor.