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Vaginal hysterectomy with or without bilateral salpingo-oophorectomy may be an alternative treatment for endometrial cancer patients with medical co-morbidities precluding standard surgical procedures: a systematic review
  1. Arnold-Jan Kruse1,2,3,
  2. Henk G ter Brugge1,
  3. Harm H de Haan1,
  4. Hugo W Van Eyndhoven1 and
  5. Hans W Nijman4
  1. 1 Department of Obstetrics and Gynecology, Isala Hospital, Zwolle, The Netherlands
  2. 2 Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
  3. 3 GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
  4. 4 Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Arnold-Jan Kruse, Department of Obstetrics and Gynecology, Isala Clinics, Zwolle 8000, The Netherlands; a.j.kruse{at}isala.nl

Abstract

Objective Vaginal hysterectomy with bilateral salpingo-oophorectomy may be an alternative strategy for patients with low-risk endometrial cancer and medical co-morbidities precluding laparoscopic or abdominal procedures. The current study evaluates the prevalence of co-existent ovarian malignancy in patients with endometrial cancer and the influence of bilateral salpingo-oophorectomy on survival outcomes in these patients.

Methods Medline and EMBASE were searched for studies published between January 1, 2000 and November 20, 2017 that investigated (1) the prevalence of co-existing ovarian malignancy (either metastases or primary synchronous ovarian cancer in women with endometrial cancer, and (2) the influence of bilateral salpingo-oophorectomy on recurrence and/or survival rates.

Results Of the pre-menopausal and post-menopausal patients (n=6059), 373 were identified with metastases and 106 were identified with primary synchronous ovarian cancer. Of the post-menopausal patients (n=6016), 362 were identified with metastases and 44 were identified with primary synchronous ovarian cancer. Survival outcomes did not differ for pre-menopausal patients with endometrial cancer with and without bilateral salpingo-oophorectomy (5-year overall survival rates were 89–94.5% and 86–97.8%, respectively).

Conclusion Bilateral salpingo-oophorectomy during vaginal hysterectomy seems to have a limited impact on disease outcome in patients with endometrial cancer. These results support the view that vaginal hysterectomy alone or with bilateral salpingo-oophorectomy may be an option for patients with endometrial cancer who are not ideal surgical candidates.

  • endometrial cancer
  • comorbidity
  • vaginal hysterectomy
  • salpingo-oophorectomy
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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned, externally peer reviewed.

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