The treatment of vaginal carcinoma recurrence in a neovagina with laser skinning colpectomy

The 59-year-old patient was admitted to a dysplasia consultation for the first time following repeated unsucccesfull antimycotic treatment.

During colposcopy we confirmed a squamous cell cervical cancer and carcinoma in situ with focal microinvasion in the left vaginal wall.

The patient then underwent radical hysterectomy and adenectomy, pelvic and para-aortic lymphonodectomy, radical colpectomy in the upper vaginal area, laser skinning colpectomy with adhesiolysis in the lower vagina area. We decided to create a neovagina by way of an omentum graft . We decided not to use skin grafts and reconstructed the posterior wall with transposition flaps. Reepitheliarisation proceeded correct. The final tumour stage was T2b, N0 (0/59), L0, V0, R0.

During a routine check-up 1 year after the primary therapy, we saw invasion in the posterior vaginal wall. In the biopsy we again secured a microinvasive squamous cell carcinoma. We decided not to make an excision in the area of the neovagina, instead we used the CoLaSCo technique.

Histologically, we confirmed a microinvasive vaginal carcinoma (rpT1, rpTis, R0). The further course was regular.

The Colasco technique is based on superficial laser excision under colposcopic control along the lamina vasorum with about 2-3 mm penetration depth. In patients with post-vaginal hysterectomy, excision was performed after considering and taking into account the corners of the vaginal stump. The effectiveness of this procedure is very high.

Our case shows recurrence of a vaginal carcinioma in the omentum only a short time after reconstruction of the vagina.

The recurrence could be treated very effectively with CoLasco.

Publication History

Article published online:
11 October 2022