Laparoscopic Resection of Vaginal Cuff Recurrence Following Surgery for Endometrial Cancer.

Abstract

OBJECTIVE: Vaginal cuff recurrence of endometrial cancer is generally managed with radiotherapy, and surgical reports are scarce. We report a laparoscopic resection technique for isolated vaginal cuff recurrence. METHODS: A 57-year-old woman underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy for grade 1 endometrioid carcinoma (FIGO stage IA) without adjuvant therapy. Nine months postoperatively, she was referred to our hospital with suspected vaginal cuff and pelvic lymph node recurrence. Imaging revealed no invasion of adjacent organs, and lymph nodes were deemed resectable. RESULTS: Laparoscopic resection of the vaginal cuff tumor and pelvic lymphadenectomy were performed. Following the principles of radical hysterectomy, the bilateral cardinal ligaments, uterosacral ligaments, and the anterior and posterior layers of the vesicouterine ligaments were divided. The vaginal canal was circumferentially incised, and the recurrent tumor was excised. As paravaginal tissue invasion was not suspected, the hypogastric nerves were preserved. Specimens were retrieved transvaginally in protective bags. Histopathological examination confirmed recurrent grade 3 endometrioid carcinoma with negative margins and pelvic nodal metastases. Postoperative chemotherapy was administered, and the patient remains disease-free. CONCLUSION: This technique represents a valuable therapeutic option, providing safe and definitive resection for patients with vaginal cuff recurrence.