The choice of approach in the surgical management of endometrial carcinoma: a retrospective serie of 155 cases

Setting. Retrospective study of patients consecutively managed surgically for apparent stage I endometrial carcinoma in a comprehensive cancer center, using a standardized protocol for the choice of surgical approach: laparoscopically assisted vaginal hysterectomy (LAVH) as standard procedure, vaginal surgery in apparent stage IA grade I or in patients in poor medical condition, laparotomy in the case of subserous myometrial involvement at imaging or in patients with enlarged uteri or in the presence of a contra-indication to laparoscopy, Material and methods, Excluding 2 patients in whom laparoscopy was converted in laparotomy, and I patient who had a full laparoscopic hysterectomy, the records of 155 patients were reviewed. All patients had a preoperative sonogram, and 74% had a preoperative MRL Preoperative data, preoperative staging, operative data, pathological staging, postoperative complications, recurrence and survival were recorded. Results. 69 patients (43.6%) had a LAVH procedure (group LAVH),. 58 patients (36.7%) were treated by laparotomy (group TAH), and 28 patients (18%) were treated by simple vaginal hysterectomy (group VH). Patients in the vaginal group were significantly heavier (VH 91.3 kg +/- 33, range 53-175) than those of the other two groups (TAH 76.5 +/- 12.7, range 48-142 : LAVH 71.1 +/- 18.5, range 47-102). The number of large (> 10 cm) uteri was significantly greater in the TAH group (46.5%) than the LAVH group (26.1%, p = 0.02) or the VH group (14.3%, p = 0.007). Myometrial invasion was suspected in 53.6% of the VH group, 72.6% of the LAVH group, and 71.4% of the TAH group. Deep myometrial invasion was suspected in no patient of the VH group, 14.5% of the LAVH group and 70.7% of the TA H group. The LAVH group had a significantly longer mean operative time than the TAH group or the VH group. The number of perioperative complications was significantly higher in the TA H group (22.4%) compared to the LAVH group (5.6%) and the VH group (0%). Blood loss was significantly elevated in the laparotomy group compared to the other two groups. The mean number of nodes removed was significantly higher in the LAVH group (15.8 +/- 7.8, range 4-37) compared to the TAH group (11 +/- 5.3, range 2-25 p = 0.002). Of 155 patients, 100 (64.5%) had correct preoperative staging. In 19 (12.3%) FIGO stage was overestimated preoperatively. and in 36 (23.2%) the FIGO stage was underestimated preoperatively. Survival curves were not found significantly different between groups.