Pre- and Postoperative Evaluation, Morbidity, and PostoperativeOutcome of Elderly Gynecological Cancer Patients

Abstract

Background: Cancer is primarily a disease of older adults, with over 50% of new diagnoses and 70% of mortality occurring in individuals over 65 years. Despite this heavy burden, older patients remain severely underrepresented in landmark oncology clinical trials. Unfounded fears of high postoperative morbidity often lead clinicians to deliver sub-optimal surgical treatment or withhold curative therapies entirely.Methods: We synthesized data from major landmark international trials published by the European Society of Gynaecological Oncology (ESGO) and the European Journal of Surgical Oncology (EJSO). The analyzed metrics focused heavily on the clinical utility of the Comprehensive Geriatric Assessment (CGA), the Preoperative Assessment of Cancer in the Elderly (PACE) instrument, the impact of intraoperative hypothermia, and standard modern Enhanced Recovery After Surgery (ERAS) pathways in elderly oncological cohorts.Results: Large-scale multi-center prospective studies confirmed that chronological age alone does not associate with the occurrence of severe postoperative complications. Adherence to ERAS protocols remains exceptionally high among the elderly. However, multi-system vulnerabilities such as abnormal baseline Instrumental Activities of Daily Living (IADL) and intraoperative hypothermia (<36.0°C) served as aggressive independent predictors of early 30-day morbidity. Specifically, surgical hypothermia demonstrates a critically high risk for deep vein thrombosis/pulmonary embolism (VTE/PE) events (OR 3.53) and significantly degrades median overall survival from 45 months down to 34 months.Conclusions: Functional status, rather than chronological age, must remain the principal factor determining surgical candidacy in gynecological oncology. Implementing specialized multi-professional frameworks combining aggressive temperature management, structured non-opioid pain regimes, and standard 4-week LMWH thromboprophylaxis achieves favorable clinical outturns without denying standard curative therapies to older populations.