Dipartimento Scienze della Salute della Donna e del Bambino e Sanità Pubblica, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.
Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy.
Ann Surg Oncol. 2021 Jun;28(6):3281-3290. doi: 10.1245/s10434-020-09207-w. Epub 2020 Oct 15.
Reporting the perioperative and survival outcomes of vaginectomy with respect to a matched series of pelvic exenteration (PE) in women with isolated recurrent cervical cancer.
The records of vaginal recurrent cervical cancer patients admitted at Fondazione Policlinico "Agostino Gemelli" IRCCS in Rome from January 2010 to June 2019 were retrospectively analyzed. A propensity-matched score analysis was performed by age, clinical stage, disease-free interval, and R0 resection. Postsurgical complications and survival rates were evaluated.
Fifteen women underwent vaginectomy, and 30 patients were submitted to PE. No statistical differences were observed between the two groups at baseline characteristics. The vaginectomy procedures were successfully performed in all women, and no case required conversion to PE. Moreover, a higher rate of major postoperative complications after PE with respect to vaginectomy (p = 0.027) was recorded. Among them, three women required reoperation within 30 postoperative days, and four experienced two or more complications. Twenty-five (55.6%) women experienced recurrence: 8 of 25 (32.0%) in the vaginectomy group, and 17 of 25 (68%) in the PE group, with a median progression-free survival of 20 months and 13 months, respectively (p = 0.169). In total, 5 of 15 (33.3%) died of disease in the vaginectomy group and 13/30 (43.3%) in the PE group, with a median overall survival of 39 and 18 months for vaginectomy and PE, respectively (p = 0.161).
The vaginectomy seems to allow for salvage treatment, such as radiotherapy and/or PE, but with a minimal impact on the quality of life in appropriately selected women with local recurrent cervical cancer.
报告阴道切除术治疗孤立性复发性宫颈癌患者的围手术期和生存结果，并与同期接受盆腔廓清术（PE）的患者进行匹配系列比较。
回顾性分析 2010 年 1 月至 2019 年 6 月期间在罗马的 Fondazione Policlinico“Agostino Gemelli”IRCCS 收治的阴道复发性宫颈癌患者的病历资料。采用年龄、临床分期、无疾病间隔期和 R0 切除进行倾向评分匹配分析。评估术后并发症和生存率。
15 例患者接受了阴道切除术，30 例患者接受了 PE。两组患者在基线特征上无统计学差异。所有患者均成功完成阴道切除术，无病例需要转为 PE。此外，PE 术后的主要并发症发生率高于阴道切除术（p=0.027）。其中，3 例患者在术后 30 天内需要再次手术，4 例患者出现 2 种或以上并发症。25 例（55.6%）患者出现复发：阴道切除术组 8 例（32.0%），PE 组 17 例（68%），无进展生存期分别为 20 个月和 13 个月（p=0.169）。在阴道切除术组中，5 例（33.3%）患者死于疾病，PE 组中 13 例（43.3%）患者死于疾病，总生存期分别为 39 个月和 18 个月（p=0.161）。
阴道切除术似乎可以进行挽救性治疗，如放疗和/或 PE，但对于选择适当的局部复发性宫颈癌患者，对生活质量的影响最小。
