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Therapie des Rezidivs beim Vulva- und Vaginalkarzinom

Treatment of recurrent vulvar and vaginal carcinoma

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Methode

Diese retrospektive Analyse betrachtet Patientinnen mit einem rezidivierten Vulva- oder Vaginalkarzinom. Abhängig von Tumorgröße und Lokalisation wurde das gesamte operative Spektrum zwischen Tumorexzision und radikaler Vulvektomie mit Kolpektomie und Exenteration eingesetzt. Hierdurch ließen sich eine gute lokale Kontrolle sowie ein günstiger Krankheitsverlauf erreichen.

Ergebnisse

Plastische Rekonstruktionen führten zu höherer Operabilität und günstigerer Wundheilung. Für kleine Defekte erwiesen sich fasziokutane Lappenplastiken als sichere Operationsverfahren. Bei großen Wunden zeigten sich gluteale Oberschenkellappen als optimales Operationsverfahren für hintere Defekte und M. rectus-abdominis-Plastiken für anteriore Rezidive. Nach vorausgegangener Strahlentherapie wurden überwiegend myokutane Lappenplastiken eingesetzt und führten zu vergleichbar günstigeren Heilungsergebnissen als ohne Bestrahlung.

Schlussfolgerung

Für die Rezidivoperationen gelten die gleichen Radikalitätsprinzipien wie für die Primäroperation. Die Maßnahmen sollten tumoradaptiert durchgeführt werden. Insbesondere bei vorbestrahlten Rezidiven des Vulvakarzinoms sind myokutane Lappenplastiken aus Sicht dieser Untersuchung unerlässlich.

Abstract

Objective

In this retrospective analysis,186 patient cases of recurrent vulvar or vaginal carcinoma were examined regarding pretreatment, surgical therapy, plastic reconstruction, and postoperative disease course.

Results

Therapy was individualized according to tumor status using the complete spectrum of surgical interventions. Plastic reconstruction led to improvements with respect to operability, wound healing, and survival. For minor defects, local (fasciocutaneous) flaps proved to be reliable operative techniques. In cases exhibiting larger wounds, the use of regional (myocutaneous) flaps produced satisfactory results. For posterior defects, gluteal thigh flaps were the safest procedures, whereas for anterior defects, flaps from the rectus abdominis muscle proved to be most successful.

Conclusion

Our analysis shows that individualized reconstructive surgery leads to good local control and satisfactory patient outcome in patients with recurrent vulvar cancer. Surgical procedures for recurrent vulvar carcinoma require the same principles of radicality as for primary tumors. To an even greater extent than for primary therapy, plastic surgery enlarges the spectrum of feasible surgical alternatives, especially after radiotherapy.

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  1. Klinikum der Stadt Ludwigshafen, Frauenklinik, Bremserstraße 79, 67063, Ludwigshafen, Deutschland

    W. Weikel

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Weikel, W. Therapie des Rezidivs beim Vulva- und Vaginalkarzinom. Onkologe 15, 76–81 (2009). https://doi.org/10.1007/s00761-008-1543-6

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  • DOI: https://doi.org/10.1007/s00761-008-1543-6

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