Naldini Angelica, Rossitto Cristiano, Morciano Andrea, Panico Giovanni, Campagna Giuseppe, Paparella Pierluigi, Scambia Giovanni
Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
Int J Surg Case Rep. 2014;5(8):455-8. doi: 10.1016/j.ijscr.2014.05.011. Epub 2014 Jun 4.
The current management of vulvar cancer depends on the extension of disease, and includes primary tumor resection with safety margin as well as inguinofemoral lymph node staging. We report the case of the first leg videoendoscopic inguinal lymphadenectomy performed in a woman with a squamous cell vulvar carcinoma.
A 74 years old female referred to our institution complaining of vulvar mass associated with bleeding and swelling from external genitals, vaginal burning sensation and dysuria for 5 months. A vulvar-vaginal examination under narcosis reported a right major labium lesion of 5cm with an irregular and ulcerated surface, easily bleeding on palpation, involving anteriorly the clitoral region and with a histological finding of a poorly differentiated squamous cell invasive carcinoma of the vulva ulcerating the surface epithelium. We performed, after adequate informed consent, a radical vulvectomy with a standard right inguinofemoral lymphadenectomy and a contralateral simultaneous video endoscopic inguinal lymphadenectomy-Leg procedure.
Our minimally invasive VEIL-Leg approach, performed for the first time in literature in a woman with vulvar cancer, could reduce the presence of high risk factors represented by surgical incision and by procedure-related complications, including wound infection and breakdown, hematoma, cellulitis and hernia formation.
A multicenter prospective randomized study will be helpful to clarify how this procedure could replace the standard laparotomic approach to inguinal lymphadenectomy in the vulvar cancer treatment and staging.
目前外阴癌的治疗取决于疾病的分期，包括切除带有安全切缘的原发性肿瘤以及腹股沟股淋巴结分期。我们报告了首例在一名患有外阴鳞状细胞癌的女性中进行的腿部视频内镜腹股沟淋巴结清扫术的病例。
一名74岁女性因外阴肿物伴外生殖器出血、肿胀、阴道烧灼感和排尿困难5个月转诊至我院。麻醉下的外阴-阴道检查发现右侧大阴唇有一个5厘米的病变，表面不规则且溃疡，触诊易出血，前部累及阴蒂区域，组织学检查发现为低分化鳞状细胞浸润性外阴癌，表面上皮溃疡。在获得充分知情同意后，我们进行了根治性外阴切除术、标准的右侧腹股沟股淋巴结清扫术以及对侧同步视频内镜腹股沟淋巴结清扫术-腿部手术。
我们的微创视频内镜腹股沟淋巴结清扫术-腿部手术首次在文献中应用于外阴癌女性患者，可减少手术切口及与手术相关并发症（包括伤口感染与裂开、血肿、蜂窝织炎和疝形成）所代表的高危因素。
一项多中心前瞻性随机研究将有助于阐明该手术如何在治疗和分期外阴癌时取代标准的开放性腹股沟淋巴结清扫术。
