Consider Vaginal Route in Ca With Comorbidities


HOT SPRINGS, VA. — Total vaginal hysterectomy may be an appropriate therapy for patients with endometrial cancers whose medical comorbidities put them at increased risk of complications with standard surgery, Dr. Susan Smith said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

She presented a retrospective review of 63 patients who underwent vaginal hysterectomy for proven or presumed endometrial cancer. Their average age was 62 years; 70% were obese, with an average weight of 235 pounds. Most (80%) had at least two comorbidities that put them at increased risk of intra- or postoperative complications, including hypertension (75%), cardiovascular disease (40%), diabetes (40%), or pulmonary disease (27%), as well as obesity. About half of the group had three or more coexisting factors, said Dr. Smith of the University of South Florida, Tampa.

The average operating time was 119 minutes, with an average blood loss of 330 cc. Only two patients (3%) had to be converted to a laparotomy during the surgery.

There were no perioperative deaths, and more than half of the patients (57%) had no postoperative complications. The most common complications were fever (16%), blood transfusion (11%), and prolonged hospital stay (6%). Fewer than 5% of patients had a postoperative infection (cuff cellulitis, pneumonia, or urinary tract infection).

Follow-up ranging from 6 months to 7 years was available for 44% of the patients. None of these had any evidence of disease at their last visit, but five had needed adjuvant therapy.

“More patients did need additional therapy, but their records were not available for review in this study,” Dr. Smith said.

“Careful screening and a frank, informed discussion of this nontraditional approach and its implications” are necessary before proceeding with this treatment track, she said.

A hysterectomy by laparotomy is the preferred method of treating endometrial cancer in women who have a good surgical risk-benefit ratio, Dr. Matthew Burrell, a gynecologic oncologist from Atlanta, noted in discussing the report.

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