THE ROLE OF VAGINAL HYSTERECTOMY IN THE TREATMENT OF ENDOMETRIAL CARCINOMA

Between 1964 and 1991, vaginal hysterectomy was performed in 60 patien ts with clinical stage I endometrial carcinoma, who were not considere d candidates for the conventional surgical approach. Of these patients , 66.7% were obese with a median weight of 235 pounds. Other risk fact ors included hypertension (63%), diabetes mellitus (34%), cardiac dise ase (28%) and pulmonary disease (12%). Operative mortality was 0%. The complication rate was 14%, with four patients requiring transfusions and four patients developing vaginal cuff cellulitis. Forty per cent o f patients received adjuvant pre- or postoperative radiation therapy. Crude survival at 5 and 10 years was 91.1% and 87.1%, respectively. Ho wever, only one patient died from disease 6 years after primary treatm ent. Although we consider surgical staging as the standard of care for the treatment of endometrial cancer, vaginal hysterectomy has a defin ite place in the management of patients with good prognostic criteria who are at high operative risk for the standard surgical approach.