Long term outcomes of vaginal hysterectomy for endometrial cancer

Abstract

<h3>Objectives:</h3> We examined the use and long-term outcomes of vaginal hysterectomy for women with early-stage endometrial cancer. <h3>Methods:</h3> The Surveillance, Epidemiology, and End Results-Medicare database was used to identify women with stage I-II endometrial cancer treated with primary hysterectomy from 2000-2015. Multivariable 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. <h3>Results:</h3> A total of 19,212 patients including 837 (4.6%) who underwent TVH were identified. Performance of vaginal hysterectomy declined from 4.5% in 2000 to 2.2% in 2015 (P<0.0001). In a multivariable model, advanced age and living in an urban area were associated with performance of TVH. 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. There was no association between either overall co-morbidity (Charlson index) or any individual comorbidities and performance of TVH. Women with high grade tumors were less likely to undergo TVH. Five-year survival was 78.4% (95% CI: 77.6-79.2) in those who underwent abdominal hysterectomy, 83.3% (95% CI: 82.1-84.4) in those who had a laparoscopic hysterectomy and 80.9% (95% CI: 77.8-83.5) in those who underwent TVH. In multivariable models, there was no adverse impact between TVH and either overall (HR=1.06; 95% CI, 0.94-1.19) or cancer-specific (HR=0.95; 95% CI, 0.70-1.28) survival. <h3>Conclusions:</h3> Use of vaginal hysterectomy for stage I/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.