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• W1986248565 abstract "We were interested to read the report by Smith and Hoffman,1Smith S.M. Hoffman M.S. The role of vaginal hysterectomy in the treatment of endometrial cancer.Am J Obstet Gynecol. 2007; 197 (e1-6): 202PubMed Google Scholar and Burrell's and Smith's discussion of this article.1Smith S.M. Hoffman M.S. The role of vaginal hysterectomy in the treatment of endometrial cancer.Am J Obstet Gynecol. 2007; 197 (e1-6): 202PubMed Google Scholar The authors provided indirect evidence to support the recent concept of using the fertility-sparing or conservative surgery or therapy for malignancies in women that the use of conservative modalities can be applied in the management of endometrial cancers because there are many reports showing that endometrial cancers can be treated with a simple diagnostic dilatation and curettage followed by some potent hormone therapy, including a progestin agent, in highly selected young women who would like to preserve their fertility potential.2Gershenson D.M. Fertility-sparing surgery for malignancies in women.J Natl Cancer Inst Monogr. 2005; 34: 43-47Crossref PubMed Scopus (89) Google Scholar Of course, we know that the use of vaginal hysterectomy in the management of endometrial cancer in this article1Smith S.M. Hoffman M.S. The role of vaginal hysterectomy in the treatment of endometrial cancer.Am J Obstet Gynecol. 2007; 197 (e1-6): 202PubMed Google Scholar is not for the purpose of fertility preservation; the purpose of this approach based on an awareness of the morbidity of this standard operation, including total hysterectomy, bilateral salpingo-oophorectomy, and lymphoidectomy, may outweigh the risk of endometrial cancer itself2Gershenson D.M. Fertility-sparing surgery for malignancies in women.J Natl Cancer Inst Monogr. 2005; 34: 43-47Crossref PubMed Scopus (89) Google Scholar because these women have high-risk and comorbid conditions.1Smith S.M. Hoffman M.S. The role of vaginal hysterectomy in the treatment of endometrial cancer.Am J Obstet Gynecol. 2007; 197 (e1-6): 202PubMed Google Scholar This rationale was challenged by Burrell1Smith S.M. Hoffman M.S. The role of vaginal hysterectomy in the treatment of endometrial cancer.Am J Obstet Gynecol. 2007; 197 (e1-6): 202PubMed Google Scholar because it is difficult to define a medically compromised status precisely, and the typical women with endometrial cancer are obese, diabetic, and hypertensive females who might well have chronic obstructive pulmonary disease, cardiovascular disease, and renal disease and might be old. We have some questions about this topic, but we should emphasize that the questions are not an argument against the previously mentioned concept. First, if these women were not suitable for standard surgical surgery, why did the authors not choose radiotherapy or high-dose hormone therapy directly? Radiotherapy alone (adding chemotherapy or not) is also a well-accepted alternative therapy for these “severely medically compromised” women with endometrial cancer, who are unsuitable for surgery. There are 3 strategies, including radiation therapy alone, high-dose progesterone therapy, and vaginal hysterectomy, and for those on the lower end of the comorbidity scale, laparoscopy, often used in the management of endometrial cancers with a “medically compromised” status. Before making a conclusion,1Smith S.M. Hoffman M.S. The role of vaginal hysterectomy in the treatment of endometrial cancer.Am J Obstet Gynecol. 2007; 197 (e1-6): 202PubMed Google Scholar the authors should discuss this weak point. In fact, Burrell has addressed this weak point, but he did not ask for an answer. Second, why did 2 patients convert to laparotomy if they were really unsuitable for laparotomy or laparoscopy? Third, is it meaningful to accept women with endometrial cancer who have not received a complete surgical staging or who have preserved their ovaries if these patients were diagnosed as endometrial cancer, grade I or stage I, accidentally? Is it acceptable to consider that the value of adjuvant therapy is as effective as that of complete staging surgery? If postoperative adjuvant therapy is not avoidable or not necessary for all, why does the “well-known concept” show that we should perform complete surgical staging for these patients who were diagnosed as endometrial cancers accidentally after hysterectomy, either from an abdominal approach, vaginal approach, or laparoscopic approach? The majority, if not all, of recent publications have favored the benefits of complete surgical staging surgery for endometrial cancer, not only for the cost-effectiveness but also for the outcome.3Ayhan A. Kart C. Guven S. Boynukalin K. Kucukali T. The role of reoperation in the management of endometrial carcinoma found in simple hysterectomy.J Surg Oncol. 2006; 93: 373-378Crossref PubMed Scopus (4) Google Scholar Fourth, we are very concerned about the 9 subjects treated with total hysterectomy combined with an episiotomy procedure and 19 subjects combined with a prolapse procedure1Smith S.M. Hoffman M.S. The role of vaginal hysterectomy in the treatment of endometrial cancer.Am J Obstet Gynecol. 2007; 197 (e1-6): 202PubMed Google Scholar because all the extra procedures may increase operative time and the risk of tumor implantation, which might exacerbate the medically compromised status of the patients and possibly worsen the outcome. There are sporadic reports of rapid tumor growth or implantation in episiotomy wounds in gynecological cancers.4Wang P.H. Yen M.S. Yuan C.C. et al.Port site metastasis after laparoscopic-assisted vaginal hysterectomy for endometrial cancer: Possible mechanisms and prevention.Gynecol Oncol. 1997; 66: 151-155Crossref PubMed Scopus (112) Google Scholar This is worthy of our special attention. The role of vaginal hysterectomy in the treatment of endometrial cancerAmerican Journal of Obstetrics & GynecologyVol. 197Issue 2PreviewThe objective of the study was to evaluate the role of vaginal hysterectomy in the treatment of endometrial cancer. Full-Text PDF" @default.
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• W1986248565 title "Vaginal hysterectomy for endometrial cancers" @default.
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