The purpose of this study was to analyze the outcome of vaginal and abdominal hysterectomy for treatment of endometrial cancer in elderly patients. In a retrospective series of 171 patients with age ≥ 70 years and at stages I- III, we evaluated operative and hospitalization data, as well as morbidity, mortality, and long- term survival associated with vaginal and abdominal hysterectomy. A total of 128 patients were operated on with vaginal hysterectomy and 43 cases underwent abdominal hysterectomy. Medically compromised patients were significantly more frequent in the vaginal surgery group (P = 0.01). Overall, the 10- year disease- specific survival rates after vaginal and abdominal hysterectomy were 80% and 78% , respectively (P = n.s.). Limiting the analysis to stage I (130 patients), 10- year disease- specific survival was 83% in 95 women operated on by the vaginal route and 84% in 35 patients operated by the abdominal approach (P = n.s.). Patients in the vaginal surgery group had a significantly shorter operative time (P = 0.01), less blood loss (P< 0.05), and were discharged earlier (P < 0.05). Severe complications occurred in 5.4% of the vaginal and in 7.0% of the abdominal procedures. Perioperative mortality was zero after vaginal hysterectomy and 2.3% after abdominal hysterectomy, respectively. Vaginal hysterectomy showed a high cure rate, shorter operative time, less blood loss, reduced morbidity, and no mortality and therefore may be considered the elective approach for treatment of elderly patients with endometrial cancer.
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