Vaginal Hysterectomy for Treatment of Endometrial Cancer, 30 Years of Experience

Laurel K Berry, Laura M Harbin, Amy E Wahlquist, Emily M Green, Alex M Drohan, Tommy R Buchanan, Benjamin M Muller, Jennifer Y Pierce, Matthew F Kohler, Paul B Underwoodand William T Creasman

Wake Forest Baptist Health, USA
Department of Obstetrics and Gynecology, Medical University of South Carolina, USA
Washington University in St. Louis, USA
University of South Alabama, USA

^*Correspondance to: William T Creasman 

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Abstract:

Objective: It has been suggested that Vaginal Hysterectomy (VH) be considered for the treatment of low-risk Endometrial Cancer (EC) patients, but prior studies have been limited by patient selection, sample size and histology [1-3]. VH has been used judiciously over the last 30 years for treatment of EC at our institution. The objective of our study is to validate VH for the treatment of EC for select patients by evaluating oncologic outcomes.
Methods: Retrospective review of all EC patients treated at Medical University of South Carolina from 1987 to 2017 was performed. Patients were included if they had preoperative pathology with grade 1 endometrioid (type 1) EC and if they subsequently underwent Vaginal Hysterectomy (VH) +/- Bilateral Salpingo-Oophorectomy (BSO), Abdominal Hysterectomy (AH) +/- BSO, or Robotic Hysterectomy (RH) +/- BSO. For the purpose of our study, no patients with lymph node assessment
were included. VH patients were compared to AH and RH patients with regard to the following: Age, race, BMI, comorbidities, number of days hospitalized, incidence of post-op-transfusion (s), postoperative infection(s), postoperative morbidity and readmission. When oncologic outcomes were evaluated, the AH and RH groups were similar and therefore VH patients were compared to AH+RH patients with regard to hysterectomy pathology, recurrence, disease free survival and
overall survival.
Results: Sixty patients underwent VH and 111 underwent AH (n=76) or RH (n=35) for grade 1 endometrioid EC. Demographic differences and perioperative differences between the three groups were evaluated (Table 1 and 2). VH patients were noted to have significant differences in BMI and rates of comorbidities when compared to both AH and RH patients. Demographic and perioperative outcomes were superior in the VH group compared to the AH group, no difference was noted between the VH and RH groups. Recurrence rated disease-free survival, and overall survival was similar between the VH and AH+RH groups with no statistically significant difference.
Conclusion: Vaginal hysterectomy may be utilized in medically at risk Endometrial Cancer (EC) patients with oncologic outcomes similar to EC patients treated via the abdominal route whenever lymph node assessment is not feasible or not indicated.

Keywords:

Vaginal hysterectomy; Endometrial cancer; AH; RH; BMI

Cite the Article:

Berry LK, Harbin LM, Wahlquist AE, Green EM, Drohan AM, Buchanan TR, et al. Vaginal Hysterectomy for Treatment of Endometrial Cancer, 30 Years of Experience. Clin Oncol. 2020;5:1751..