Annals of Surgical Oncology

, 11:219 | Cite as

Perioperative Morbidity and Mortality in Elderly Gynecological Oncological Patients (≥70 Years) by the American Society of Anesthesiologists Physical Status Classes

  • Raffaella Giannice
  • Elvira Foti
  • Antonella Poerio
  • Elisabetta Marana
  • Salvatore Mancuso
  • Giovanni Scambia
Original Articles


Background: We evaluated the morbidity and mortality associated with American Society of Anesthesiologists (ASA) classes III and IV versus ASA classes I and II in elderly women (≥70 years) undergoing gynecological oncological surgery.

Methods: From 1986 to 2000, we retrospectively collected patients ≥70 years of age undergoing oncological gynecological surgery. The study population consisted of 121 ASA class III and IV patients. The control group consisted of the same number of patients with ASA classes I and II, and these were matched to study patients (1:1) by clinical and surgical data. The morbidity and mortality of patients with ASA status III and IV were analyzed before and after 1992.

Results: In ASA class III and IV patients, compared with ASA class I and II, a higher rate of severe morbidity (P = .000) occurred, whereas the median postoperative stay was similar (8 days). No differences between patients with ASA class III and IV and ASA class I and II for median operative time, transfusion rate, or median blood loss were found. Mortality was 3% in ASA classes III and IV.

Conclusions: Our study suggests that surgery in elderly gynecological oncological patients aged ≥70 years with ASA class III or IV results in an acceptable perioperative morbidity and mortality rate.

Key Words

Elderly patients Morbidity Mortality Gynecological cancer Oncological surgery ASA classes 


  1. 1.
    Baranovsky A, Myers MH. Cancer incidence and survival in patients 65 years of age and older. CA Cancer J Clin 1986;36:26–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 1997;80:1273–1283.PubMedCrossRefGoogle Scholar
  3. 3.
    United Nations Department for Economic and Social Information and Policy Analysis, Population Division. World Population Prospects: The 1994 Revision. Document ST/ESA/SER/A/145. New York: United Nations, 1995.Google Scholar
  4. 4.
    Turner NJ, Haward RA, Mulley GP, Selby PJ. Cancer in old age is inadequately investigated and treated?. BMJ 1999;319:309–312.PubMedGoogle Scholar
  5. 5.
    Monfardini S. What do we know on variables influencing clinical decision-making in elderly cancer patients?. Eur J Cancer 1996;32A:12–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Massad LS, Vogler G, Herzog TJ, Mutch DG. Correlates of length in gynecologic oncologic patients undergoing surgery. Gynecol Oncol 1993;51:214–218.PubMedCrossRefGoogle Scholar
  7. 7.
    Susini T, Scambia G, Margariti PA, et al. Gynecologic oncologic surgery in the elderly: a retrospective analysis of 213 patients. Gynecol Oncol 1999;76:287–289.Google Scholar
  8. 8.
    Nusbaum NJ. How do geriatric patients recover from surgery?. South Med J 1996;89:950–957.PubMedCrossRefGoogle Scholar
  9. 9.
    Lawton FG, Hacker NF. Surgery for invasive gynecologic cancer in the elderly female population. Obstet Gynecol 1990;76:287–289.PubMedGoogle Scholar
  10. 10.
    Kennedy AW, Plagg JS, Webster KD. Gynecologic cancer in the elderly. Gynecol Oncol 1989;32:49–54.PubMedCrossRefGoogle Scholar
  11. 11.
    Walsh TH. Audit of outcome of major surgery in the elderly. Br J Surg 1996;93:92–97.CrossRefGoogle Scholar
  12. 12.
    Fuchtner C, Manetta A, Walker JL, Emma D, Berman M, Di Saia PJ. Radical hysterectomy in the elderly patient: analysis of morbidity. Am J Obstet Gynecol 1992;166:593–597.PubMedGoogle Scholar
  13. 13.
    De Rijke DM, Schouten LJ, Volovics A, Van Der Puttens HWHM. Age specific differences in treatment and survival of ovarian cancer patients in the province of Limberg, The Netherlands 1986–1992. Int J Gynecol Cancer 1998;8:150–157.CrossRefGoogle Scholar
  14. 14.
    Hightower RD, Nguyen HN, Averette HE, Hoskins W, Harrison T, Sterem A. National survey of ovarian carcinoma IV: pattern of care and related survival for older patients. Cancer 1994;73:377–383.PubMedCrossRefGoogle Scholar
  15. 15.
    Gloecker Ries LA. Ovarian cancer. Survival and treatment differences by age. Cancer 1993;71:524–529.Google Scholar
  16. 16.
    Ceccaroni M, D’Agostino G, Ferrandina G, et al. Gynecological malignancies in the elderly patients: is age 70 a limit to standard-dose chemotherapy? An Italian retrospective toxicity multicentric study. Gynecol Oncol 2002;85:445–450.PubMedCrossRefGoogle Scholar
  17. 17.
    Nordin AJ, Dixon S, Chinn DJ, Naik R, Lopes AdB, Monaghan JM. Attitudes to radical gynecologic oncologic surgery in the elderly: pilot study. Int J Gynecol Cancer 2000;10:323–329.PubMedCrossRefGoogle Scholar
  18. 18.
    Monfardini S, Aapro M, Ferrucci L, Zagonel V, Scalliet P, Fentiman I. Commission of the European Communities “Europe Against Cancer” Programme. European School of Oncology advisory report. Cancer treatment in the elderly. Eur J Cancer 1993;16:2325–2330.CrossRefGoogle Scholar
  19. 19.
    Lewin I, Lerner AG, Green SH, Del Guercio LRM, Siegel JH. Physical class and physiologic status in the prediction of operative mortality in the aged sick. Ann Surg 1971;174:217–231.PubMedCrossRefGoogle Scholar
  20. 20.
    Kaplan JA. Thoracic Anesthesia. 2nd ed. New York: Churchill Livingstone, 1991:143–57, C6.Google Scholar
  21. 21.
    Kaplan JA. Thoracic Anesthesia. 2nd ed. New York: Churchill Livingstone, 1991:1–16, C1.Google Scholar
  22. 22.
    Benedetti-Panici P, Scambia G, Baiocchi G, Maneschi F, Greggi S, Mancuso S. Radical hysterectomy: a randomized study comparing two techniques for resection of the cardinal ligament. Gynecol Oncol 1993;50:226–231.PubMedCrossRefGoogle Scholar
  23. 23.
    Benedetti-Panici P, Maneschi F, Cutillo G, et al. Modified type IV-V radical hysterectomy with systematic pelvic and aortic lymphadenectomy in the treatment of patients with stage III cervical carcinoma. Cancer 1996;78:2359–2365.PubMedCrossRefGoogle Scholar
  24. 24.
    Benedetti-Panici P, Maneschi F, Scambia G, Cutillo G, Greggi S, Mancuso S. The pelvic retroperitoneal approach in the treatment of advanced ovarian carcinoma. Obstet Gynecol 1996;87:532–538.PubMedCrossRefGoogle Scholar
  25. 25.
    Benedetti-Panici P, Maneschi F, Scambia G, Mancuso S. A new transabdominal approach to the left retroperitoneum for systematic removal of lymph nodes of the aorta in gynecologic malignancies. Obstet Gynecol 1994;83:1060–1064.PubMedCrossRefGoogle Scholar
  26. 26.
    Benedetti-Panici P, Scambia G, Baiocchi G, Greggi S, Mancuso S. Technique and feasibility of radical para-aortic and pelvic lymphadenectomy for gynecologic malignancies: a prospective study. Int J Gynecol Cancer 1991;1:133–144.CrossRefGoogle Scholar
  27. 27.
    Morley GW, Nichols DH. Gynaecological and obstetrical surgery: surgical treatment of vulvar carcinoma. CIC (Centro Italiano Congressi) International Edition. Rome, 1995:275–80.Google Scholar
  28. 28.
    Benedetti-Panici P, Maneschi F, Cutillo G, et al. A randomized study comparing retroperitoneal drainage with no drainage after lymphadenectomy in gynecologic malignancies. Gynecol Oncol 1997;65:478–482.PubMedCrossRefGoogle Scholar
  29. 29.
    Piver S, Rutledge F, Smith JP. Five classes of extended hysterectomy. Am J Obstet Gynecol 1974;44:265–272.Google Scholar
  30. 30.
    Chassagne D, Sismondi P, Sinistrero G, et al. A glossary of reporting complications of treatment in gynecologic cancer. Radiother Oncol 1993;26:195–202.PubMedCrossRefGoogle Scholar
  31. 31.
    Dean MM, Finan MA, Kline RC. Predictors of complications and hospital stay in gynecologic cancer surgery. Obstet Gynecol 2001;97:721–724.PubMedCrossRefGoogle Scholar
  32. 32.
    Kirschner CV, De Serto TM, Isaacs JK. Surgical treatment of the elderly patient with gynecologic cancer. Surg Gynecol Obstet 1990;170:379–384.PubMedGoogle Scholar
  33. 33.
    Pedersen T. Complications and death following anaesthesia. A prospective study with special reference to the influence of patient-, anaesthesia-, and surgery-related risk factors. Dan Med Bull 1994;41:319–331.PubMedGoogle Scholar
  34. 34.
    Kirschner CV, De Serto TM, Isaacs JK. Surgical treatment of the elderly patient with gynecologic cancer. Surg Gynecol Obstet 1990;170:379–384.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2004

Authors and Affiliations

  • Raffaella Giannice
    • 1
    • 2
  • Elvira Foti
    • 1
  • Antonella Poerio
    • 1
  • Elisabetta Marana
    • 3
  • Salvatore Mancuso
    • 1
  • Giovanni Scambia
    • 1
    • 4
  1. 1.Department of Obstetrics and GynaecologyCatholic University of Sacred Heart of RomeRomeItaly
  2. 2.Department of Obstetrics and GynaecologyCivil Hospital of LegnanoMilanItaly
  3. 3.Department of AnaesthesiologyCatholic University of Sacred Heart of RomeRomeItaly
  4. 4.Department of Obstetrics and GynaecologyCatholic University of Sacred HeartRomeItaly

Personalised recommendations