Vaginal Hysterectomy and Abdominal Hysterectomy for Treatment of Endometrial Cancer in the Elderly

This study presents the results of a retrospective review of all women (n = 171) older than 70 years of age who underwent surgery for treatment of endocervical cancer between 1980 and 1999 at the University of Florence. Women who were obese, or who were otherwise considered poor surgical risks, had a vaginal hysterectomy, always with bilateral salpingo-oophorectomy and removal of a short vaginal cuff (1–2 cm). Healthy women, or those with a large uterus or coexistent adnexal mass, underwent abdominal hysterectomy and bilateral salpingo-oophorectomy. Pelvic lymphadenectomy was done at the surgeon’s discretion. Patients with poorly differentiated disease or deep myometrial invasion received postoperative adjuvant whole-pelvis irradiation. Follow up was at 3- month intervals for 2 years, every 6 months until 5 years, and once a year thereafter. The median follow-up period was 67 months. Patients who died of other causes were considered to have survived until the time of their death. The mean age of patients was 74 years. Vaginal hysterectomy with bilateral salpingo-oophorectomy was performed in 128 women (75%), 11 of whom also had extraperitoneal pelvic lymphadenectomy. Most of these patients (85%) had spinal anesthesia. Forty-three patients (25%) had abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy in 27 patients. There was no significant difference in the 2 groups in rates of disease recurrence or death from disease. Seventeen of 128 patients (13.3%) in the vaginal hysterectomy group and 8 of 43 patients (18.6%) in the abdominal group died of disease. Only 1 patient, who had undergone a vaginal procedure, of 26 with disease recurrence did not die of disease. There was no significant difference between the groups in the pattern of disease recurrence. Recurrence was local in 44.4% and 50% of the vaginal and abdominal hysterectomy groups, respectively. Distant metastases were seen in 33.3% and 25%, and distant and local in 22.2% and 25%, respectively. No significant differences in survival were seen. Overall 5-year and 10-year survival rates were 84% and 80%, respectively, in the vaginal group and 78% each in the hysterectomy group. The 38 patients who underwent pelvic lymphadenectomy, only 3 of whom (7.9%) had positive nodes, had 5- and 10-year survival rates (82% each) that were similar to overall survival rates. Five percent of the women in the vaginal hysterectomy group and 7% of those in the abdominal group had serious complications associated with surgery (cerebral vascular accident, wound dehiscence, ureteral stricture, bowel obstruction, or myocardial failure). One patient in the abdominal group died from myocardial infarction. Fewer patients who had a vaginal procedure had general anesthesia (15% vs. 100% in the abdominal group; P <.001), median operative time was shorter (46 minutes vs. 115 minutes; P = .01), median blood loss was less (210 mL vs. 400 mL; P = .01), and hospital stays were shorter (median 6 days vs. 10 days; P = .05) compared with the abdominal hysterectomy group. Requirements for blood transfusion were not significantly different.