Washington University in St Louis School of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, 660 S. Euclid Ave, St Louis, MO 63110, USA.
Gynecol Oncol. 2013 Jun;129(3):528-32. doi: 10.1016/j.ygyno.2013.02.033. Epub 2013 Mar 6.
The objectives of this study are to determine the utility of re-excision after a primary diagnosis of vulvar carcinoma by assessing the frequency of residual carcinoma found upon re-excision and to quantitate the wound breakdown and carcinoma recurrence rates.
We reviewed 1122 cases of VIN or vulvar carcinoma. Women who underwent re-excisional procedures, as part of their initial surgical treatment were identified. Associations between the margin status of the original excisional sample and histology of re-excision, as well as association between the depth of invasion upon initial excision and histology of re-excision were analyzed with Chi-square tests.
We identified 84 evaluable patients, 72 with stage I disease, 4 with stage II, and 7 with stage III disease. Upon the initial excisional procedure, 33 patients (39%) had carcinoma-positive margins, 27 patients had VIN-positive margins (32%) and 24 patients (28%) had negative margins (>1mm). Upon re-excision, 1/24 (4%) patients with negative margins, 2/27 (7%) patients with VIN-positive margins, and 11/33 (33%) patients with carcinoma-positive margins were found to have carcinoma in the re-excision specimens (p<0.0001, χ(2)=31). Deeper tumor invasion of the initial excisional specimen (1-12mm) was associated with a higher chance of finding carcinoma upon re-excision (range 18-42%, depending on depth of invasion) (p=0.015, χ(2)=19). Nineteen patients (23%) had vulvar wound breakdown post re-excision. Twelve patients (15%) experienced recurrences.
The yield of micro- or invasive carcinoma at re-excision is low, with a high wound breakdown rate. Re-excision should be considered for patients with margins positive for carcinoma, especially for women with deep invasion, while women with VIN or close but clear margins may be followed.
本研究旨在通过评估再次切除时残留癌的检出率，以及量化伤口破裂和癌复发率，来确定外阴癌初次诊断后再次切除的效用。
我们回顾了 1122 例 VIN 或外阴癌病例。确定了行再次切除手术的患者。采用卡方检验分析了初次切除标本的切缘状态与再次切除标本的组织学之间的关系，以及初次切除时的浸润深度与再次切除标本的组织学之间的关系。
我们确定了 84 例可评估患者，72 例为 I 期疾病，4 例为 II 期疾病，7 例为 III 期疾病。初次切除时，33 例（39%）患者的切缘有癌阳性，27 例（32%）患者的切缘有 VIN 阳性，24 例（28%）患者的切缘为阴性（>1mm）。再次切除时，24 例（28%）阴性切缘患者中有 1 例（4%）、27 例（32%）VIN 阳性切缘患者中有 2 例（7%）、33 例（39%）癌阳性切缘患者中有 11 例（33%）在再次切除标本中发现癌（p<0.0001，卡方=31）。初次切除标本的肿瘤侵袭深度（1-12mm）越深，再次切除时发现癌的可能性越高（范围为 18-42%，取决于侵袭深度）（p=0.015，卡方=19）。19 例（23%）患者在再次切除后出现外阴伤口破裂。12 例（15%）患者出现复发。
再次切除的微浸润或浸润性癌的检出率较低，但伤口破裂率较高。对于癌阳性切缘的患者，尤其是浸润较深的患者，应考虑再次切除，而对于 VIN 或切缘接近但清晰的患者，可以进行随访。
