ASO Author Reflections: Robotically Assisted Gynecologic Surgery in the Frail Elderly: Analysis of Perioperative Outcome
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Robotically Assisted Gynecologic Surgery in the Frail Elderly: Analysis of Perioperative Outcomes Alessia Aloisi, MD1,2, and Mario M. Leitao Jr., MD1,3 Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; 2European Institute of Oncology, Milan, Italy; 3Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 1
During the past 50 years, economic and technologic advancements have led to a significant increase in life expectancy. In the United States, individuals 65 years of age or older will account for approximately 20% of the population by 2030. During the same period, the number of individuals older than 75 years is expected to triple, and the number of individuals older than 85 years is expected to double.1 An aging population poses unique medical practice challenges, especially with regard to surgery. Elderly patients often have multiple comorbidities and can be frail, putting them at greater risk for the development of postoperative complications. Minimally invasive surgery (MIS) can be a good alternative to open surgery for this patient population because MIS is associated with fewer complications without any compromise of surgical aggressiveness or outcomes. However, data regarding MIS for the elderly, especially those older than 80 years, are scarce.2 Based on the authors’ previous experience, in which they reviewed the surgical outcomes for 982 elderly patients (median age, 71 years) who had undergone a gynecologic procedure, robotically assisted surgery appeared to be safe for this patient population, even for those 85 years of age or older, a group generally at higher risk for unfavorable outcomes. Although robotically assisted surgery appeared safe for these patients, age of 85 years or older still was significantly associated with
Ó Society of Surgical Oncology 2020 First Received: 20 April 2020; Published Online: 7 May 2020 M. M. Leitao Jr., MD e-mail: [email protected]
major complications. Moreover, body mass index, age of 85 years or older, and occurrence of a major complication were significantly associated with 90-day mortality,3 underscoring the need for careful patient selection in these scenarios. The authors speculated that these unfavorable outcomes may have been due to increased frailty caused by multiple comorbidities, impaired physical activity, and reduced performance status. As such, they sought to compare the characteristics of the frail elderly with those of the non-frail elderly patients in the cohort. They defined frailty phenotype based on the presence of three of the following five frailty factors: comorbidities ([ 5), low physical activity (inability to walk more than 1 block), weight loss, exhaustion (inability to walk up 1 flight of stairs), and fatigue.4 According to the author’s review of 71 frail patients, frailty was not associated with 90-day mortality risk. However, the frail elderly still should be considered as at high risk, because in the review, this
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