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RADICAL LEFT HEMIVULVECTOMY, SUPERFICIAL RIGHT HEMIVULVECTOMY AND SENTINEL LYMPH NODE WITH INDOCYANINE GREEN
Abstract
Introduction
Vulvar cancer accounts for 3-5% of malignant diseases of the female genital tract. The surgical management remains complex, because it can concern two types of patients, on the one hand elderly patients with heavy comorbidities, on the other hand younger patients with a high risk of alteration of the quality of life and sexuality.
Description
We present the case of a 68 year-old woman, treated for a 20 mm squamous cell carcinoma of left hemivulva and high‐grade vulvar intraepithelial neoplasia of left and right labia minora and clitoris. This patient is eligible for a sentinel node procedure. This surgical film shows a left radical hemivulvectomy, a right superficial hemivulvectomy and identification of bilateral sentinel lymph node with indocyanine green.
Conclusion/Implications
Improvements like sentinel lymph node procedure in treatment of vulvar cancer contribute to the decrease of mortality and morbidity. The possibility of performing a hemivulvectomy also allows to reduce the consequences of vulvar surgery in a de-escalation strategy.
ROBOT-ASSISTED RADICAL COLPOPARAMETRECTOMY IN VAGINAL CANCER
Abstract
Introduction
Vaginal cancer is rare, and robotic-assisted surgical treatment is an exploratory field. The objective of this case report is to describe the robotic technique and the oncological results of a 37-year-old patient, two gravida two deliveries, who underwent a simple hysterectomy due to a persistent high-grade cervical lesion.
Description
Three years later, she presented a high-posterior vaginal wall nodule. The colposcopy-guided biopsy revealed squamous cell carcinoma, while the MRI showed a 4.6cm mass with no suspicious pelvic lymph nodes or lateral extension. A robot-assisted laparoscopic radical colpoparametrectomy with pelvic lymph node dissection and ovarian transposition was performed, combined with transvaginal closure of the vaginal cuff for oncologic safety. The procedure seemed feasible and standardized. The surgical length was 520 minutes with 100cc estimated blood loss. The patient was discharged on day-2, and the bladder function resumed on day-7. The final pathologic analysis revealed a 5.0cm tumor in the vaginal cuff extended to surrounding soft tissue, parametria bilaterally, and anterior and posterior surgical margins were microscopically compromised. There were six positive lymph nodes of the 21 removed. The following adjuvant radiotherapy and chemotherapy were based on the Star Trial, and the patient did not show pelvic recurrence after a 14-month follow-up. Although, she presented an isolated supramesenteric retroperitoneal metastasis outside of the radiotherapy field.
Conclusion/Implications
The development of robot-assisted techniques for the treatment of vaginal cancer becomes progressively more relevant considering the diffusion of robotic systems in surgical practice. The safety maneuvers could keep oncological principles in these surgeries.