title: Laparoscopic-assisted vaginal hysterectomy versus total laparoscopic hysterectomy for the management of endometrial cancer: a randomized clinical trial.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital Varese, Verona, Italy. fabio.ghezzi@uninsubria.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Valentino
authors.initials: V
authors.lastname: Bergamini
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.forename: Paolo
authors.initials: P
authors.lastname: Beretta
authors.forename: Massimo
authors.initials: M
authors.lastname: Franchi
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Bolis
mesh_terms: 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