Total Laparoscopic Hysterectomy versus Laparoscopic-Assisted Vaginal Hysterectomy in Endometrial Cancer: Surgical and Survival Outcomes

Study Objective: To compare surgical and survival outcomes of patients with early-stage endometrial cancer (EC) who underwent total laparoscopic hysterectomy (TLH) or laparoscopic-assisted vaginal hysterectomy (LAVH) ± lymphadenectomy. Design: Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). Setting: Two tertiary care academic medical centers. Patients: Patients with EC treated by TLH or LAVH from 1998 through 2006. Interventions: TLH and LAVH were performed in 80 and 24 patients, respectively. Patient demographics and clinical variables were collected, and surgical and survival outcomes were determined. Measurements and Main Results: Median operating time was significantly higher for patients undergoing LAVH than for those undergoing TLH (212.5 and 183.5 minutes, respectively; p = .039). EBL was also greater in patients undergoing LAVH (median 220 mL) compared with those undergoing TLH (median100 mL; p = .001). After a median follow-up time of 51.5 months, there was no difference in recurrence or survival rates between the groups. Conclusion: Early-stage EC can be treated effectively with either TLH or LAVH. TLH patients may experience shorter operating times and less blood loss. When performed by experienced laparoscopists, TLH may be more feasible than LAVH in this cohort of patients.