Laparoscopy-assisted vaginal hysterectomy compared with abdominal hysterectomy in clinical stage I endometrial cancer: safety, recurrence, and long-term outcome

Abstract

Objective: To determine the feasibility of laparoscopic-assisted vaginal hysterectomy (LAVH) in the treatment of clinical FIGO stage I endometrial adenocarcinoma and long-term survival outcome.

Study design: Prospective cohort study without randomization of 169 consecutive patients. Laparoscopy or laparotomy was selected based on size and mobility of the uterus and Body Mass Index (BMI). Lymphadenectomy was only performed in cases at high-risk for nodal metastases.

Results: Sixty-nine patients (41%) treated successfully by LAVH (LAVH group) while 100 (59%) by total abdominal hysterectomy (TAH) (laparotomy group). Four out of 73 patients initially approached by laparoscopy were converted to laparotomy (5.5%). Lymphadenectomy was performed in 40% of the LAVH and 57% of TAH group (P = 0.03). The median number of pelvic lymph nodes removed by LAVH and laparotomy was 15 (range 2-31) and 21 (range 2-65), respectively (P = 0.05). LAVH was associated with more surgical FIGO stage IA disease and a smaller tumor diameter. Operative time was significantly longer with laparoscopy compared with laparotomy, while blood loss and duration of hospitalization was significantly lower in the LAVH group. The recurrence rate in the LAVH group was 8.7%, compared with 16% in the laparotomy group (not significant, NS). The actuarial overall survival (OS) and disease-free survival (DFS) for the LAVH were 93% and 91% compared with 86% and 84% in the TAH, respectively (NS). In the multivariate analyses histological subtype was the only independent prognostic factor for DFS, while surgical technique was not.

Conclusion: LAVH with lymphadenectomy in selected population in high-risk patients with clinical stage I endometrial adenocarcinoma and with favorable body mass index of less than 35 kg/m2, appears to be safe procedure.