文摘
Background Five percent to 20% of stage I endometrial cancer patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy develop vaginal and pelvic recurrences. Adjuvant radiotherapy can improve locoregional control but not survival. This randomized trial aimed to determine whether a modified radical (Piver–Rutledge class II) hysterectomy can improve survival and locoregional control compared to the standard extrafascial (Piver–Rutledge class I) hysterectomy. Methods Eligible patients (n?=?520) with stage I endometrial cancer were randomized to class I or class II hysterectomy. Primary endpoint was overall survival. Results The median length of parametria and vagina removed were 15 and 5 vs. 20?mm and 15?mm for class I and class II hysterectomy, respectively (P?>?0.001). Operating time and blood loss were statistically significantly higher for class II hysterectomy. At a median follow-up of 70?months, 51 patients had died. Five-year disease-free and overall survival were similar between arms (87.7 and 88.9% in the class I arm and 89.7 and 92.2% in the class II arm, respectively). The unadjusted hazard ratios for recurrence was 0.91 (95% confidence interval, 0.55-.51, P?=?0.72), and the hazard ratio for death was 0.77 (95% confidence interval, 0.44-.33, P?=?0.35). Conclusions Class II hysterectomy did not improve locoregional control and survival compared to class I hysterectomy, but when an adequate vaginal cuff transection is not feasible with class I hysterectomy, a modified radical hysterectomy allows to obtain an optimal vaginal and pelvic control of disease with a minimal increase in surgical morbidity.