High incidence of positive peritoneal cytology in low-risk endometrial cancer treated by laparoscopically assisted vaginal hysterectomy

Objective. Laparoscopically assisted vaginal hysterectomy (LAVH) has evolve d into an alternative form of surgical management in the treatment of low-r isk endometrial cancer. The purpose of this study was to determine whether low-risk endometrial cancer patients are subject to a higher incidence of p ositive peritoneal cytology when treated with LAVH compared to total abdomi nal hysterectomy (TAH). Methods. We retrospectively reviewed the medical records of patients with l ow-risk endometrial cancer (grade 1-2 endometrioid type with no evidence of extrauterine spread or grade 3 with <50% myometrial invasion (MI), no cerv ical or adnexal involvement, and negative lymph nodes when sampled) treated at Memorial Sloan-Kettering Cancer Center from January 1993 to September 1 999. We compared 131 patients treated with LAVH to 246 controls who underwe nt TAH. The two groups were compared for known prognostic factors including grade, MI, vascular space involvement, and lower uterine segment extension . Results. The mean age of patients who underwent LAVH (61 years) was similar to that of the controls (62 years). Fourteen (10.3%) of the patients treat ed with LAVH had positive peritoneal cytology compared to only 7 (2.8%) of the control population. Factors including FIGO grade, myometrial invasion, and preoperative hysteroscopy did not influence the final results. When str atifying for these factors, the odds ratios of having positive peritoneal w ashings in those patients treated by LAVH were 5.2, 5.2, and 3.7, respectiv ely. Conclusion. Treatment of low-risk endometrial cancer by LAVH is associated with a significantly higher incidence of positive peritoneal cytology. This may be due to the retrograde dissemination of cancer cells into the perito neal cavity during uterine manipulation. The clinical significance of these findings is yet to be determined. (C) 2001 Academic Press.