Laparoscopic-assisted vaginal hysterectomy versus total laparoscopic hysterectomy in endometrial cancer: A retrospective cohort study

OBJECTIVE: The methods of laparoscopic staging surgery (LSS) for endometrial cancer can generally be classified into two approaches: laparoscopic-assisted vaginal hysterectomy (LAVH)-based LSS and total laparoscopic hysterectomy (TLH)-based LSS. This study aims to compare perioperative and oncologic outcomes between LAVH-based LSS and TLH-based LSS. MATERIALS AND METHODS: Between January 2019 to December 2024, 118 patients who underwent laparoscopic staging surgery were retrospectively observed. Patient characteristics, such as age, BMI, parity, disease extension, histology subtypes, estimated blood loss, operative time, complications and recurrence were collected and analyzed. RESULTS: TLH was associated with significantly lower estimated blood loss compared with LAVH (119.0 ± 69.9 vs. 218.5 ± 375.1 mL, p = 0.036). TLH also offered a tendency of shorter operative time but without significance (197.40 ± 50.74 vs. 214.41 ± 66.89 min, p = 0.135). While hospital stay, complication rate, and 30-day re-hospitalization were comparable between groups. Four recurrences were observed, all in the LAVH group. Kaplan-Meier analysis showed no significant difference in progression-free survival (p = 0.300). CONCLUSION: TLH-based LSS in early-stage EC appears a safe approach, offering reduced blood loss without compromising perioperative or oncologic outcomes compared with LAVH-based LSS.