Original article
Laparoscopic-assisted vaginal hysterectomy versus total laparoscopic hysterectomy for the management of endometrial cancer: A randomized clinical trial

https://doi.org/10.1016/j.jmig.2005.11.013Get rights and content

Abstract

Study objective

To compare laparoscopic-assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for the treatment of endometrial cancer.

Design

Randomized, controlled trial.

Design classification

Randomized controlled trial (Canadian Task Force classification I).

Setting

Two gynecologic oncologic units of university hospitals.

Patients

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

Interventions

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

Measurements and main 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.

Conclusion

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.

Section snippets

Materials and methods

Consecutive women with endometrial cancer surgically managed from July 2003 through February 2005 in two academic gynecology departments were randomized to undergo either LAVH (LAVH group) or TLH procedure (TLH group). Women were offered the laparoscopic approach regardless of parity, body mass index (BMI), and surgical history. A uterine size ≥12 weeks, age over 75 years, severe cardiopulmonary comorbidity, and evidence of metastatic disease at preoperative workup were considered as exclusion

Results

During the study period, a total of 81 patients were referred to our departments for the surgical treatment of endometrial cancer. Of these, eight (9.9%) were not eligible for randomization because of a large uterus (n = 1), age over 75 (n = 5), and history of heart failure or pulmonary obstructive disease contraindicating prolonged Trendelenburg position (n = 2). In one patient the laparoscopic procedure was converted to laparotomy before randomization to control a significant hemorrhage

Discussion

A MEDLINE search using the terms “endometrial cancer,” “laparoscopy,” “laparoscopic-assisted vaginal hysterectomy,” and “total laparoscopic hysterectomy” revealed that this is the first randomized trial comparing LAVH and TLH for the surgical management of endometrial cancer. Our findings suggest that both LAVH and TLH are feasible and safe treatment options for women with endometrial cancer, with similar surgical outcomes. The difference in mean operative time between the study groups appears

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