The role of vaginal hysterectomy in the treatment of endometrial carcinoma.
Between 1964 and 1991, vaginal hysterectomy was performed in 60 patients with clinical stage I endometrial carcinoma, who were not considered candidates for the conventional surgical approach. Of these patients, 66.7% were obese with a median weight of 235 pounds. Other risk factors included hypertension (63%), diabetes mellitus (34%), cardiac disease (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 of patients received adjuvant pre- or postoperative radiation therapy. Crude survival at 5 and 10 years was 91.1% and 87.1%, respectively. However, only one patient died from disease 6 years after primary treatment. Although we consider surgical staging as the standard of care for the treatment of endometrial cancer, vaginal hysterectomy has a definite place in the management of patients with good prognostic criteria who are at high operative risk for the standard surgical approach.
Lellé
R.J.
RJ
Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Michigan and Puget Sound Oncology Consortium, Seattle, Washington, USA.
Morley
G.W.
GW
Peters
W.A.
WA