Vaginal hysterectomy as primary treatment of endometrial cancer in medically compromised women

Objective:To study the survival, rates and patterns of recurrence, and peri operative morbidity in medically compromised women with endometrial cancer treated by primary vaginal hysterectomy. Methods: Fifty-one patients with endometrial cancer treated initially by va ginal hysterectomy between 1977 and 1999 were identified at the University of California, Irvine Medical Center and affiliated hospitals. Data were re trieved from hospital and office records. Statistical analysis, including K aplan-Meier methods, was performed and the disease-specific survival rates were estimated. This study has 80% power to demonstrate a greater than 20% improvement in 5-year survival over historical controls. Results: Fifty-one women with uterine carcinoma clinically confined to the uterus underwent primary vaginal hysterectomy with (n = 26) or without (n = 25) salpingo-oophorectomy. Eighty-four percent were obese with a body mass index greater than 27. Additional risk factors for surgical complications included hypertension (57%), diabetes mellitus (27%), and cardiovascular di sease (18%). One-third of patients had three or more risk factors. Surgical morbidity included one episode of acute hemorrhage necessitating transfusi on and abdominal exploration. Blood transfusions were given to four additio nal patients. There were no perioperative deaths. Five women recurred and e xpired at a median of 13 months (range 3-53 months) after surgery. The 3- a nd 5-year disease-specific survival rates were 91.4% and 88.0%, respectivel y. Conclusion: Vaginal hysterectomy for the initial treatment of early-stage e ndometrial cancer is associated with a high rate of cure and minimal morbid ity. Thus, it may be considered a reasonable alternative to the abdominal a pproach in medically compromised women. (Obstet Gynecol 2001;97: 707-11. (C ) 2001 by The American College of Obstetricians and Gynecologists.).