Surgical treatment of endometrial cancer: does closure or non-closure of the vagina affect the local recurrence rate?

Background: Laparoscopic surgery in patients with endometrial cancer has been more widely used in the last 5-10 years, and numerous reports concerning recurrence rate and the surgical technique, laparoscopic vs. open, have been published. However, no data are available concerning the surgical technique of an open or closed vaginal cuff and the vaginal recurrence rate in patients with endometrial cancer.

Patients And Methods: Medical records of 273 patients with endometrial cancer first diagnosed between January 2000 and December 2005 have been reviewed. All patients underwent total abdominal hysterectomy (TAH) or laparoscopically assisted vaginal hysterectomy (LAVH), bilateral salpingo-oophorectomy, peritoneal washings at the Department of Gynecology and Obstetrics of the Medical University of Vienna, Austria. Pelvic lymphadenectomy was performed in high risk patients with grade 3, grade 2 > 2 cm diameter, adeno-squamous, clear cell or papillary serous histology, tumor invading the outer half of the myometrium and cervical extension.

Results: Thirty-two out of 273 patients with endometrial cancer had recurrent disease. Sixteen patients out of 126 with primary closure of the vaginal cuff had recurrent disease, 8 of them locally; 12 patients out of 130 with open vaginal cuff had recurrent disease, 6 of them locally. Four patients out of 17 with no available information had recurrent disease, 2 of them locally. No significant correlation between the local recurrence rate and surgical technique was found (Spearman's correlation coefficient 0.001, p = 0.994).

Conclusion: The surgical technique of an open or closed vaginal cuff during open or laparoscopic surgery for endometrial cancer showed no significant impact on the local recurrence rate.