Ovarian cancer in the elderly: impact of surgery on morbidity and survival.

BACKGROUND: Elderly ovarian cancer patients often undergo non-optimal surgery due to their age despite of the high risk of recurrence. The aim of this study was to determine if more postoperative complications occurred in patients over 70 years and to compare extent of surgery with younger patients.

MATERIALS AND METHODS: Between 2001 and 2009, 172 patients with ovarian cancer were included. We compared patient characteristics, surgical course, postoperative complications and outcome for patients under and over 70 years.

RESULTS: 143 patients were under 70 years and 29 over. There were no difference between the two groups for tumors characteristics, time of surgery, FIGO stage, standard surgical procedures and rate of optimal resection. Patients over 70 years had less peritoneal surgery (p < 0.001) especially diaphragmatic surgery (p = 0.006), pelvic (p = 0.02) and para-aortic (p = 0.003) lymphadenectomy. There was no difference in the occurrence of per- or post-operative complications and patients over 70 years had shorter duration of hospitalization (p = 0.04). There was no difference between the two groups for disease-free survival (DFS) (p = 0.08) but overall survival (OS) was better in patients under 70 years (p = 0.002).

CONCLUSION: Elderly ovarian cancer patients undergo less extensive surgery and have lower OS despite similar postoperative morbidity, optimal resection and DFS. OS decrease could be explained by difference in the management of recurrences.