Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: Clinical outcomes and hospital charges

Objective. Our objective was to compare the clinical outcomes and associate d hospital charges between two methods of hysterectomy for patients with ea rly-stage endometrial cancer. Methods. Retrospective chart review of 320 patients with early-stage endome trial cancer treated by laparoscopic-assisted vaginal hysterectomy (LAVH) o r total abdominal hysterectomy (TAH) was performed for the period of July 1 , 1991, to September 30, 1996, at Memorial Sloan-Kettering Cancer Center. Results. Sixty-nine patients (22%) were treated by LAVH, and 251 (78%) were treated by TAH. The majority of the patients (80%) had Stage I disease. Th e mean age was similar for both groups: 60 years for the LAVH vs 61 years f or TAH. The mean weight was significantly lower for the LAVH group, 71 kg ( range 43-117 kg), than for the TAH group, 82 kg (range 38-200 kg), (P < 0.0 5). Overall complication rates were lower among patients treated by LAVH. O perating room time was longer for the LAVH group (214 min) than for the TAH group (144 min) (P < 0.05). The median length of stay was significantly sh orter for patients treated by LAVH (2.0 days) compared to TAH (6.0 days) (P < 0.05). Room charges were significantly higher for the TAH patients ($696 0) compared to the LAVH patients ($3130) (P < 0.05). Overall mean total cha rges were significantly less for the LAVH group ($11,826) than for the TAH group ($15,189) (P < 0.05). With a median follow-up of 30 months for the TA H group and 18 months for the LAVH group, there was no significant differen ce in disease recurrence (P = 0.91). Conclusion. Patients treated by LAVH for early-stage endometrial cancer had significantly shorter hospitalization and fewer complications, resulting i n less overall hospital charges when compared to patients treated by TAH. L ong-term outcome was similar. Laparoscopic-assisted vaginal hysterectomy is an attractive alternative for selected patients with early-stage endometri al cancer. (C) 1999 Academic Press.