Vaginal hysterectomy and abdominal hysterectomy for treatment of endometrial cancer in the elderly

Objective: The purpose of this study was to analyse the outcome of vaginal and abdominal hysterectomy for treatment of endometrial cancer in elderly patients. Methods: In a retrospective series of 171 patients with age > 70 years and stage I-III , we evaluated operative and hospitalisation data, as well as morbidity, mortality and long-term survival associated with vaginal and abdominal hysterectomy. A total of 128 patients were operated on with vaginal hysterectomy and 43 cases underwent abdominal hysterectomy. Results: Medically compromised patients were significantly more frequent in the vaginal surgery group (p=0.01). Overall, the10-year disease specific survival after vaginal and abdominal hysterectomy were 80% and 78%, respectively (p=n.s.). Limiting the analysis to stage I (130 patients) 10-year disease specific survival was 83% in 95 women operated on by the vaginal route and 84% in 35 patients operated by the abdominal approach (p=n.s.). Patients in the vaginal surgery group had a significantly shorter operative time (p= 0.01), less blood loss (p<0.05) and were discharged earlier (p<0.05). Severe complications occurred in 5.4% of the vaginal and in 7.0% of the abdominal procedures. Perioperative mortality was zero after vaginal hysterectomy and 2.3% after abdominal hysterectomy, respectively. Conclusions: Vaginal hysterectomy showed a high cure rate, shorter operative time, less blood loss, reduced morbidity and no mortality and therefore may be considered the elective approach for treatment of elderly patients with endometrial cancer.