VAGINAL HYSTERECTOMY VERSUS ABDOMINAL HYSTERECTOMY FOR THE TREATMENT OF STAGE-I ENDOMETRIAL ADENOCARCINOMA

OBJECTIVES: The aims of the current study were to (1) determine the ef fectiveness of vaginal hysterectomy for the treatment of stage I endom etrial cancer and (2) analyze which clinical pathologic parameters wer e independent predictors of clinical outcome. STUDY DESIGN: In a retro spective analysis, 5- and 10-year results of vaginal hysterectomy were compared with those of abdominal hysterectomy in 327 cases of stage I adenocarcinoma. No preoperative irradiation was given. Overall, 180 p atients underwent vaginal hysterectomy, whereas 147 patients had abdom inal hysterectomy (106 cases with lymphadenectomy). The log-rank test was used for evaluation of survival differences. RESULTS: The 5- and 1 0-year survival rates (Kaplan-Meier method) were, respectively, 90% an d 87% in the vaginal hysterectomy group and 91% and 90% in the abdomin al hysterectomy group (difference not significant). The grade of diffe rentiation, depth of myometrial invasion, and age were significantly c orrelated with survival, whereas histologic type, mode of surgery, lym phadenectomy, and adjuvant radiotherapy were not. In a multivariate an alysis (Cox proportional hazards), grade of differentiation and age we re independent predictors of clinical outcome, whereas depth of myomet rial invasion lost significance. CONCLUSIONS: Vaginal hysterectomy sho wed a high rate of cure in stage I endometrial cancer. Therefore it ca n be used as an alternative to the abdominal operation in obese and po or surgical risk patients and, possibly, in selected low-risk cases.