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Long-term outcomes of vaginal hysterectomy for endometrial cancer.

Authors :: Praiss AM
Huang Y
St Clair CM
Melamed A
Khoury-Collado F
Hou JY
Gockley A
Hillyer GC
Hershman DL
Wright JD
Source :: Gynecologic oncology [Gynecol Oncol] 2022 Jan; Vol. 164 (1), pp. 105-112. Date of Electronic Publication: 2021 Nov 08.
Publication Year :: 2022
Abstract: Background: Total vaginal hysterectomy (TVH) has been proposed as an alternative to laparoscopic (TLH) and abdominal hysterectomy (TAH), particularly for women with medical comorbidities. We examined the use and long-term outcomes of vaginal hysterectomy for women with early-stage endometrial cancer. Methods: The Surveillance, Epidemiology, and End Results-Medicare database was used to identify women with stage I-II endometrial cancer treated with primary hysterectomy from 2000 to 2015. Multivariable regression models were developed to examine clinical, demographic, and pathologic factors associated with performance of TVH. The association between route of hysterectomy and cancer-specific and overall survival was examined using multivariable Cox proportional hazards models. Results: A total of 19,212 patients including 837 (4.6%) who underwent TVH were identified. Performance of TVH declined from 4.5% in 2000 to 2.2% in 2015 (P < 0.0001). Compared to patients 65-69 years of age, patients 75-79 years old (aRR = 1.46; 95% CI, 1.19-1.79) and those >80 years old (aRR = 1.60; 95% CI, 1.30-1.97) were more likely to undergo TVH. Women with high grade tumors were less likely to undergo TVH. Five-year overall and cancer specific survivals were similar for TAH, TLH, and TVH. In multivariable models, there was no association between TVH and either cancer-specific survival (HR = 0.89; 95% CI, 0.65-1.22) compared to laparoscopic hysterectomy. Conclusion: Use of TVH for stage I and II endometrial cancer has decreased in the U.S. Chronologic age is the greatest predictor of performance of TVH. Performance of TVH does not negatively impact survival for women with early-stage endometrial cancer. Competing Interests: Declaration of Competing Interest Dr. Wright has served as a consultant for and Clovis Oncology, received royalties from UpToDate, and received research funding from Merck. Dr. Hou has served as a consultant for Foundation Medicine and Natera. (Copyright © 2021 Elsevier Inc. All rights reserved.)