The selective use of vaginal hysterectomy in the management of adenocarcinoma of the endometrium.

Vaginal hysterectomy was performed in 56 patients with Stage I adenocarcinoma of the endometrium who were selected because of obesity or major medical problems that placed the patient at high risk for morbidity and death with an abdominal operation. Seventy percent of the patients were hypertensive and 29% were diabetic. The median weight for the 56 patients was 211 pounds. Ten patients who were age 40 or younger were included, and all showed signs of polycystic ovary syndrome. This subgroup of patients was significantly more obese, with a median weight of 331 pounds. Adjuvant radiation therapy was used in 32 of the 56 patients. There was one postoperative death from a pulmonary embolus, but there were few other major complications. The actuarial survival probability was 94% for all patients. With grade 1 tumors, the 5-year survival rate was 98%; with grade 2 tumors, it was 78%; and with grade 3 tumors, it was 84%. Although we do not recommend that vaginal hysterectomy become routine, it has cure rates comparable to those with abdominal hysterectomy and should be considered in patients who are a poor surgical risk, particularly patients with grade 1 tumors.