Laparoscopic-assisted vaginal hysterectomy versus total laparoscopic hysterectomy for the management of endometrial cancer: a randomized clinical trial.
OBJECTIVE
To compare laparoscopic-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for the treatment of endometrial cancer.


METHODS
Randomized, controlled trial.


METHODS
Randomized controlled trial (Canadian Task Force classification I).


METHODS
Two gynecologic oncologic units of university hospitals.


METHODS
Seventy-two women with endometrial cancer randomized to undergo either LAVH or TLH.


METHODS
Total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, and systematic pelvic lymphadenectomy.


RESULTS
Parameters of technical feasibility (operating time of hysterectomy phase, estimated blood loss, perioperative complications) were considered as major statistical endpoints. Thirty-seven women were allocated to the LAVH arm, and 35 were allocated to the TLH arm. Mean total operating time was significantly shorter in the TLH than in the LAVH group (184.0 +/- 46.0 vs 213.2 +/- 39.4 minutes, p = .003). The hysterectomy phase was longer in the LAVH than in the TLH group only in overweight (77.9 +/- 9.8 vs 68.1 +/- 9.3 min, p = .005) and obese patients (87.7+/- 13.1 vs. 62.1+/- 9.9 min, p < .0001). The median estimated blood loss during hysterectomy was similar between groups. Intraoperative complications occurred in three (8.1%) patients in the LAVH group and in one patient (2.8%) in the TLH group (p = .61). No difference was found in the postoperative complication rate between women undergoing LAVH and those who had TLH (24.3% vs 17.1%, p = .56). Within a median follow-up period of 10 months (range 3-17 months), 2 patients in the LAVH group developed recurrent disease. No port site metastasis and no vaginal cuff recurrence were detected in either group.


CONCLUSIONS
Both LAVH and TLH can be performed successfully to manage endometrial cancer, with similar surgical outcomes. Obese patients benefit more from TLH than from LAVH in terms of shorter operating time.
Ghezzi
Fabio
F
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital Varese, Verona, Italy. fabio.ghezzi@uninsubria.it
Cromi
Antonella
A
Bergamini
Valentino
V
Uccella
Stefano
S
Beretta
Paolo
P
Franchi
Massimo
M
Bolis
Pierfrancesco
P
D000231:Adenocarcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000368:Aged; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000295:instrumentation / Q000379:methods*; D015907:Hysteroscopy / Q000379:methods*; D020706:Laparoscopes; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate