ASO Authors Reflections: Vaginectomy as Surgical Treatment of Recurrent Cervical Cancer
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ASO AUTHOR REFLECTIONS
ASO Authors Reflections: Vaginectomy as Surgical Treatment of Recurrent Cervical Cancer Giuseppe Vizzielli1
, Vito Chiantera2, Alfredo Ercoli3, and Giovanni Scambia1,4
1
Dipartimento Scienze della Salute della Donna e del Bambino e Sanita` Pubblica, Division of Gynecologic Oncology, Fondazione Policlinico Universitario ‘‘Agostino Gemelli’’ IRCCS, Rome, Italy; 2Division of Gynecologic Oncology, University of Palermo, Palermo, Italy; 3Department of Obstetrics and Gynecology, University of Messina, Messina, Italy; 4 Dipartimento Scienze della Salute della Donna e del Bambino e Sanita` Pubblica, Universita` Cattolica del Sacro Cuore, Rome, Italy
PAST
PRESENT
The natural history of cervical cancer predicts that vaginal involvement is the most common occurrence in local relapse.1 Most patients with disease recurrence are initially diagnosed with advanced disease and, therefore, not amenable to radiotherapy salvage treatment due to previous intense pelvic radiotherapy regimens. This large population of patients is currently directed to demolitive procedures, such as pelvic exenteration (PE), laterally extended endopelvic resection (LEER), or laterally extended pelvic resection (LEPR).2–4 These procedures involve an acceptable but considerably reduced quality of life (QoL) outcome for the surviving patients. However, the intense focus of referral centers on a close follow-up should allow for early diagnosis of small tumors at time of relapse. Moreover, the negative experience acquired on adverse effects of radiotherapy in patients previously treated with surgery 3 led us to investigate the possible role of nondemolitive surgery (i.e., vaginectomy) as opposed to PE on selected patients affected by an isolated vaginal disease.5
To the best of our knowledge, this is the first propensitymatched study comparing survival outcomes and complication rates of vaginectomy and PE in women with isolated vaginal recurrent cervical cancer, potentially supporting the role of a bladder-sparing surgery (vaginectomy and/or simple hysterectomy) in women with: (1) vaginal lesion \ 30 mm without evidence of detrusorial or rectal muscular layer invasion; (2) no palpable paravaginal invasion; (3) negative metastatic evaluation result, including preoperative CT scan and/or PET-CT/scan. Because several patients included in this study were affected by primary tumors with detrimental prognostic factors, such as high tumor stage and/or positive lymph nodes, most of them had received pelvic radiotherapy before the diagnosis of recurrence. Nevertheless, all patients undergoing vaginectomy were able to complete the procedure without the need to resort to PE, and an R0 resection was reached in all cases.5 However, this encouraging result was accomplished by carefully selecting patients, closely studying preoperative radiological images and, although challenging to demonstrate, with the surgical expertise reached over the years by an exenterative referral center. The postoperative stay and recovery time were extremely rapid i
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