Does today's vaginal surgery still have a specific role in the treatment of endometrial cancer?

Data from the literature an d those from ~r personal case materia! of vagina! surgeryin the treatment of endometrial carcinoma lead us to the following conclusions:Although vagina! hysterectomy is not the treatment of choice for stage I endometrialcancer, this procedure may be performed in some categories of patients assuringa good tumoral contro!.Even if in the past vagina! hysterectomy was restricted to high surgical risk patients,this indication is no longer sufficient: a low prognostic risk is now requiredif this kind of surgery is to be performed.Since most pathological features can be ascertained by vagina! surgery, with anaccurate pre-surgical study of the patient and by the assessment of grade, myometrialinvasion, tumor size, and capillary-like spaces invasion, therefore, a selection of thepatients to be treated with vagina! hysterectomy is mandatory.The following findings define a low-risk subgroup:• well-differentiated tumor (Gl);• myometrial invasion reaching the inner third (MI);• tumor size less than 2 cm in diameter;• negative peritoneal cytology;• positive hormonal receptors (ER + /PR +);• histotype: adenocarcinoma, adenoacanthoma;• negative capillary-like spaces involvement (CLS);• age below 60;• negative lymphangiography (or negative RMI and TC)Many surgeons have been reluctant to perform vagina! hysterectomy .in patientswith endometrial carcinoma because of a belief that they would jeopardize the patient'schances of survival. We believe that vagina! hysterectomy has a definite piace in thetherapeutic tool kit of the gynecological oncologist. Although we do not recommendthat this procedure should be utilized routinely or indiscriminately, its use adds flexibilityto the management of selected patients with stage I endometrial carcinoma, withoutbeing detrimental to their chances of total eradication of the tumor. It is also truethat, if vagina! hysterectomy is so seldom used today in the management of endometrialcancer, it will unfortunately be used ever less frequently in the future.