Proximal Partial Vaginectomy for Vaginal Intraepithelial Neoplasia

Objective: The purpose of this study was to evaluate the use of proximal partial vaginectomy for the treatment of VaIN.

Study Design: Descriptive.

Methods: Between May 2009 and December 2017, 20 patients were identified who underwent partial vaginectomy for VaIN. The electronic medical records were reviewed and information collated.

Operative Technique: A circular incision in mid-vagina, was taken for all these patients and the upper vagina was closed over a gauze pack. The proximal vagina was then excised with the gauze inside.

Results: None of the patients had previously been treated for VaIN. The diagnosis was made on cytology/biopsy. Twelve of the 13 patients who were tested, were positive for high-risk HPV DNA, while one was negative. Thirteen (65%) had previous gynaecological surgery for cervical neoplasia (invasive cancer 6 and CIN 7) and the remaining 7 for apparent benign disease. There was one patient who went on to have a cone biopsy, and one had a modified radical hysterectomy at the same sitting. None of the patients had post-operative complications. Median hospital stay was 3 days (range 2-9). Follow-up (median 7 months, range 0-60) was available in 19 patients out of whom five had abnormal cytology, five were HPV DNA positive, and three had recurrent VaIN on follow-up biopsy and had re-excision for recurrence. One patient had vulvar intraepithelial neoplasia (VIN 3) and underwent excision. Another had CIN 3 and underwent excision of cervical stump.

Conclusions: Vaginectomy appears to be a safe and efficacious procedure for treatment of VaIN. Patients have to be followed up with cytology, HPV testing, and biopsy to exclude vagina recurrence and HPV-related lesion at another site.