Robotisch assistierte gynäkologische Chirurgie bei älteren Patientinnen – eine komparative Kohortenstudie zum perioperativen Verlauf

Zusammenfassung

Studiendesign Im Kontext der demografischen Entwicklung wurde die Hypothese aufgestellt, dass ältere Patientinnen ≥ 65 Jahre trotz höherer präoperativer Komorbidität sicher minimalinvasiv robotisch assistiert operiert werden können. Im Design einer komparativen Kohortenstudie erfolgte der Vergleich der Altersgruppen ≥ 65 Jahre („older age group“, OAG) vs. < 65 Jahre („younger age group“, YAG) nach robotisch assistierter gynäkologischer Chirurgie (RAS) in 2 deutschen Zentren.

Patientinnen und Methoden Es wurden konsekutive RAS zwischen 2016 und 2021 mit benignen oder onkologischen Indikationen an der Universitätsfrauenklinik Jena und am Robotischen Zentrum Eisenach eingeschlossen. Der Altersgruppenvergleich erfolgte hinsichtlich präoperativer Komorbidität (ASA, „Charlson Comorbidity Index“, CCI, „Cumulative Illness Rating Scale – Geriatric Version“, CIRS-G) und perioperativer Parameter einschließlich Clavien-Dindo-(CD-)Komplikationen. Es wurden Welch’s t-Tests, Chi²-Tests und exakte Tests nach Fisher durchgeführt.

Ergebnisse Es konnten n = 242 Datensätze mit OAG n = 63 (73 ± 5 J.) and YAG n = 179 (48 ± 10 J.) identifiziert werden. Patientencharakteristika und Anteil an benignen bzw. onkologischen Indikationen unterschieden sich in den Altersgruppen nicht. Komorbiditäts-Scores inkl. Adipositasanteil waren in der OAG höher: CCI (2,7 ± 2,0 vs. 1,5 ± 1,3; p < 0,001), CIRS-G (9,7 ± 3,9 vs. 5,4 ± 2,9; p < 0,001), ASA-Klasse II/III (91,8% vs. 74,1%; p = 0,004), Adipositas (54,1% vs. 38,2%; p = 0,030). Weder bei benignen noch bei onkologischen Indikationen unterschieden sich die Altersgruppen hinsichtlich perioperativer Parameter wie Operationsdauer (p = 0,088; p = 0,368), stationärem Aufenthalt (p = 0,786; p = 0,814), Hb-Abfall (p = 0,811; p = 0,058), Konversionsrate (p = 1,000; p = 1,000) und CD-Komplikationen (p = 0,433; p = 0,745).

Schlussfolgerung Bei höherer präoperativer Komorbidität in der Gruppe der älteren Patientinnen waren in den untersuchten Kohorten keine Unterschiede im perioperativen Verlauf nach robotisch assistierter gynäkologischer Chirurgie zwischen den verglichenen Altersgruppen zu finden. Das Patientinnenalter stellte keine Kontraindikation für robotische gynäkologische Chirurgie dar.

Schlüsselwörter

benigne und onkologische Indikationen - Komorbidität - Clavien-Dindo-Klassifikation - hohes Lebensalter - robotische gynäkologische Chirurgie

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