Age Related Outcomes in Patients Undergoing Cytoreductive Surgery for Advanced Stage Adnexal and Uterine Cancers [36E]

INTRODUCTION: To evaluate impact of aging on extent of surgical procedure in advanced gynecologic cancers. METHODS: Retrospective analysis of the ACS National Surgical Quality Improvement Program targeted gynecologic data was conducted to assess frequency of cytoreductive surgery (CRS) performed in patients with stage III and IV gynecologic cancers between 2014 and 2016 using ICD-9 and CPT codes. Complication rates examined across age groups: <65, 65-74 and 75+ years old. Frequencies of complications and procedures were compared between groups via chi-square tests, age-associated trends in rates were evaluated via Cochran-Armitage tests. RESULTS: Of 2858 patients, 1336 had adnexal/peritoneal cancers and 1258 had uterine cancer. CRS was performed in 76% and 21% of each diagnosis, respectively. No statistical difference in the rate of CRS by age group. Patients undergoing CRS vs. non CRS for uterine cancer had increased risk of wound complication (p=0.001), venous thrombosis (p=0.02), transfusions (p<0.001), death (p=0.01), return to OR (p<0.001), and readmission (p<0.001). Those undergoing CRS for adnexal/peritoneal cancers had increased rates of transfusions (p=0.01) and any overall complication (p=0.01). When comparing across age groups, no statistically significant difference in the rate of the following post-operative complications: wound, venous thromboembolism, urinary tract infection, transfusion, death, return to the OR, or readmission. However, patients >75 with uterine cancer who had CRS were at increased risk for sepsis (p=0.05). CONCLUSION: In appropriately selected patients, age does not appear to impact rate of CRS or majority of perioperative complications. Older patients with advanced stage gynecologic cancers should be offered surgery based on sound clinical judgement.