We retrospectively reviewed a series of women older than 70 years who had a diagnosis of FIGO stage I or stage II endometrial endometrioid adenocarcinoma. These patients were consecutively treated at our center from April 2002 to June 2006. Unfavorable histologies were excluded from the series.
Two groups were identified. A first group (group V) included medically compromised women undergoing vaginal hysterectomy for cancer. A second group (group A) included patients who underwent abdominal surgery for cancer.
Group V considered patients with risk factors for surgery as hypertension (systolic pressure > 140 mmHg and/or diastolic pressure > 90 mmHg or patients treated with antihypertensive drugs), diabetes mellitus (basal glycemia > 140 mg/dL or patients treated with insulin or oral therapy), obesity (BMI > 30 kg/m2), massive obesity (BMI > 40 kg/m2), cardiovascular diseases (history of coronary artery disease (CAD), acute myocardial infarction, heart failure, transient ischemic attack (TIA) or stroke), respiratory diseases (obstructive or restrictive patterns). Controls had, on the other hand, an apparent good medical status.
Use of American Society of Anesthesiology (ASA) classes assessed surgical risk; cases were included in ASA class IV. Group V patients were considered unfit to general anesthesia at the anesthesiologist evaluation.
Patients were clinically staged by chest X-rays, abdomino-pelvic computed tomography (CT) scans or whole abdomen magnetic resonance imaging (MRI), and trans-vaginal ultrasound (US).
A pre-operative histological diagnosis of endometrial cancer was obtained in both groups on endometrial biopsy specimens.
Group V patients underwent a total vaginal hysterectomy with bilateral salpingo-oophorectomy at a time that included a vaginal margin being at least 1,5 and maximum 2 cm. Anesthesiologists always performed a spinal anesthesia.
Group A was treated with abdominal hysterectomy with the same vaginal margin extension as above, bilateral salpingo-oophorectomy, peritoneal washing and pelvic and para-aortic node dissection. A general anesthesia was performed in all group A cases.
All the cases (both groups) who showed a high grade (grade 3), deep myometrial invasion (> than a half) or a FIGO stage II at histology were addressed to adjuvant radiotherapy.
Mean operative time, mean hospital stay, intra- and post-operative complications, DFS and OS time and the occurrence of local or distant recurrences were then evaluated.
Follow-up protocol included: recto-vaginal examination, Pap smear from the vaginal cuff, total body CT scans every 6 months; chest X-rays and mammography on a yearly basis.
Mean follow-up was 45 months for group V (range 36-70), and 49 months for group A (range 36-72). A follow-up time of 36 months was considered valid according to literature's evidence that considers a higher risk of recurrence during the first 3 years that follow surgery[9
Data are expressed as mean ± standard deviation. Non-parametric Mann-Whitney test, or χ2 test were used to compare data. Survival curves were plotted by means of Kaplan Meier method and compared by using the Log rank test. A p value lower than 0.05 was considered to be statistically significant