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Vulvakarzinom: onkochirurgische Therapie und rekonstruktive Möglichkeiten

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Intimchirurgie

Zusammenfassung

Durch die Einführung der Triple-Incision-Technik, der Sentinelnode-Biopsie und einer Zunahme der Diagnosestellung für Malignome der Vulva in früheren Stadien sind lokale kleinere Eingriffe häufiger und ausgedehnte radikale Eingriffe mit komplizierten plastischen Deckungsverfahren seltener geworden. Die Vulvachirurgie erfordert detaillierte Kenntnisse in rekonstruktiven Verfahren im Hinblick auf Lebensqualität, Funktionalität und onkologischer Sicherheit. Wundheilungsstörungen sind im urogenitalen Bereich keine Seltenheit und erfordern Erfahrung in der Auswahl der rekonstruktiven Technik und im Komplikationsmanagement. Eingriffe an der Vulva beeinträchtigen die Lebensqualität meist nachhaltig, psychisch wie auch physisch, sodass alleine Sitzen für die Patientinnen zum dauerhaften Problem werden kann. Das stadiengerechte, therapeutische Procedere beim Vorliegen eines Vulvakarzinoms wird ausführlich beschrieben und verschiedene operative Verfahren zur Defektdeckung vorgestellt.

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Notes

  1. 1.

    Bei der Triple-Incision-Technik wird das Vulvakarzinom an der Vulva lokal in toto und über separate Leistenzugänge die inguinalen Lymphknoten entfernt.

Literatur

  • Ansink A, van der Velden J (2000) Surgical interventions for early squamous cell carcinoma of the vulva. Cochrane Database Syst Rev p. CD002036. Epub date 2000/05/05. doi: 10.1002/14651858.CD002036

    Article  PubMed  Google Scholar 

  • Argenta PA, Lindsay R, Aldridge RB, Siddigui N, Burton K, Telfer JR (2013) Vulvar reconstruction using the ‘‘lotus pedal’’ fascio-cutaneous flap. Gynecol Oncol 131:726–729

    Article  Google Scholar 

  • Aviki EM, Esselen KM, Barcia SM, Nucci MR, Horowitz NS, Feltmate CM, Berkowitz RS, Orgill DG, Viswanathan AN, Muto MG (2015) Does plastic surgical consultation improve the outcome of patients undergoing radical vulvectomy for squamous cell carcinoma of the vulva? Gynecol Oncol 137:60–65

    Article  Google Scholar 

  • Benedetti Panici P, Di Donato V, Bracchi C, Marchetti C, Tomao F, Palaia I, Perniola G, Muzii L (2014) Gynecol Oncol 132:125–129

    Article  Google Scholar 

  • Buda A, Confalonieri PL, Rovati LC, Fruscio R, Giuliani D, Signorelli M, Dell’Anna T, Pirovano C, Milani R (2012) Better anatomical and cosmetic results using tunneled lotus petal flap for plastic reconstruction after demolitivie surgery for vulvar malignancy. Int J Gynecol Cancer 22:860–864

    Article  Google Scholar 

  • Chan JK, Sugiyama V, Pham H, Gu M, Rutgers J, Osann K, Cheung MK, Berman ML, Disaia PJ (2007) Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: a multivariate analysis. Gynecol Oncol 104:636–641

    Article  Google Scholar 

  • De Lorenzi F, Loschi P, Rietjens M, Sangalli C, Manconi A, Zanagnolo V, Achilarre MT, Maggioni A, Landoni F (2015) Neourethral meatus reconstruction for vulvectomies requiring resection of the distal part of the urethra. Eur J Surg Oncol 41:1664–1670

    Article  Google Scholar 

  • Frey J, Hampl M, Mueller MD, Günthert AR (2016) Should Groin Recurrence Still Be Considered as a Palliative Situation in Vulvar Cancer Patients?: A Brief Report. Int J Gynecol Cancer 26:575–579

    Article  Google Scholar 

  • Gadducci A, Ferrero A, Tana R, Fabrini MG, Modaffari P, Fanucchi A, Vignati C, Zola P (2012) Prognostic value of lymph node status and number of removed nodes in patients with squamous cell carcinoma of the vulva treated with modified radical vulvectomy and inguinal-femoral lymphadenectomy. Eur J Gynaecol Oncol 33:640–643

    Google Scholar 

  • Gentileschi S, Servillo M, Garganese G, Fragomeni S, De Bonis F, Scambia G, Salgarello M (2016) Surgical therapy of vulvar cancer: how to chosse the correct recontruction? J Gynecol Oncol 27(6):e60

    Article  Google Scholar 

  • Hampl M, Langkamp B, Lux J, Kueppers V, Janni W, Müller-Mattheis V (2011) The risk of urinary incontinence after partial urethral resection in patients with anterior vulvar cancer. Eur J Obstet Gynecol Reprod Biol 154:108–112

    Article  Google Scholar 

  • Heaps JM, Fu YS, Montz FJ, Hacker NF, Berek JS (1990) Surgical-pathologic variables predictive of local recurrences in squamous cell carcinoma of the vulva. Gynecol Oncol 38:309–314

    Article  CAS  Google Scholar 

  • Höckel M, Schmidt K, Bornmann K, Horn LC, Dornhöfer N (2010) Vulvar field resection: novel approach to the surgical treatment of vulvar cancer based on ontogenetic anatomy. Gynecol Oncol 119:106–113

    Article  Google Scholar 

  • Huang JJ, Chang NJ, Chou HH, Wu CW, Abdelrahman M, Chen HY, Cheng MH (2015) Pedicle perforator flaps for vulvar reconstruction – new generation of less invasive vulvar reconstruction with favorable results. Gynecol Oncol 137:66–72

    Article  Google Scholar 

  • Knapstein PG, Friedberg V (1987) Plastische Chirurgie in der Gynäkologie. Thieme, Stuttgart/New York

    Google Scholar 

  • Lin JY, DuBeshter B, Angel C, Dvoretsky PM (1992) Morbidity and recurrence with modifications of radical vulvectomy and groin dissection. Gynecol Oncol 47:80–86

    Article  CAS  Google Scholar 

  • Nielsen LJ, Siemssen PA, Hesselfeldt J (2016) Autologous lipografting to reconstruct the labia majora following vulvectomy. Int J Gynecaecol Obstet 134:99–100

    Article  Google Scholar 

  • Origoni M, Sideri M, Garsia S, Carinelli SG, Ferrari AG (1992) Prognostic value of pathological patterns of lymph node positivity in squamous cell carcinoma of the vulva stage III and IVA FIGO. Gynecol Oncol 45:313–316

    Article  CAS  Google Scholar 

  • Raspagliesi F, Hanozet F, Ditto A, Solima E, Zanaboni F, Vecchione F, Kusamura S (2006) Clinical and pathological prognostic factors in squamous cell carcinoma of the vulva. Gynecol Oncol 102:333–337

    Article  Google Scholar 

  • Schnürch HG, Ackermann S, Alt CD, Barinoff J, Böing C, Dannecker C, Gieseking F, Günthert A, Hantschmann P, Horn LC, Kürzl R, Mallmann P, Marnitz S, Mehlhorn G, Hack CC, Koch MC, Torsten U, Weikel W, Wölber L, Hampl M (2016) Diagnosis, Therapy and Follow-up Care of Vulvar Cancer and its Precursors. Guideline of the DGGG and DKG (S2K-Level, AWMF Registry Number 015/059, November 2015. Geburtshilfe Frauenheilkd 76:1035–1049

    Article  Google Scholar 

  • Senn B, Eicher M, Mueller MD, Hornung R, Fink D, Baessler K, Hampl M, Denhaerynck K, Spirig R, Engberg S (2013) A patient-reported outcome measure to identify occurence and distress of post-surgery symptoms of WOMen with vulvar Neoplasia (WOMAN-PRO) – a cross sectional study. Gynecol Oncol 129:234–240

    Article  Google Scholar 

  • Van der Velden J, van Lindert AC, Lammes FB, ten Kate FJ, Sie-Go DM, Oosting H, Heintz AP (1995) Extracapsular growth of lymph node metastases in squamous cell carcinoma oft he vulva. The impact on recurrence and survival. Cancer 75:2885–2890

    Article  Google Scholar 

  • Wallwiener D, Jonat W, Kreienberg R, Friese K, Dietdrich K, Beckmann MW (2008) Atlas der gynäkologischen Operationen, 7. Aufl. Thieme, Stuttgart

    Google Scholar 

  • Wolf B, Horn LC, Höckel M (2017) Anogenital lichen sclerosus: Change of tissue position as pathogenic factor. Gynecologic. Oncol Rep 20:73–74

    Google Scholar 

Weiterführende Literatur

  • Gentile M, Bianchi P, Sesti F, Sopracordevole F, Biamonti A, Scirpa P, Schimberni M, Cozza G, Marziani R, Di Martino G, Catalano A, Milazzo GN, Zinna M, Caserta D, Frega A (2014) Adjuvant topical treatment with imiquimod 5 % after excisional surgery for VIN 2/3. Eur Rev Med Pharmacol Sci 18:2949–2952

    CAS  PubMed  Google Scholar 

  • Heller DS, van Seters M, Marchitelli C, Moyal-Barracco M, Preti M, van Beurden M (2010) Update on intraepithelial neoplasia of the vulva: proceedings of a Workshop at the 2009 World Congress of the International Society for the Study of Vulvovaginal Diseases, Edinburgh, Scotland, September 2009. J Low Genit Tract Dis 14:363–373

    Article  Google Scholar 

  • Höckel M, Dornhofer N (2004) Anatomical reconstruction after vulvectomy. Obstet Gynecol 103:1125–1128

    Article  Google Scholar 

  • Wilkinson EJ, Rico MJ, Pierson KK (1982) Microinvasive carcinoma of the vulva. Int J Gynecol Pathol 1:29–39

    Article  CAS  Google Scholar 

  • Wittekind C, Meyer H (2010) UICC TNM Klassifikation maligner Tumoren. Wiley-Blackwell, Weinheim

    Google Scholar 

  • Wittekind C, Compton CC, Brirley J, Supplement LHSTNM (2012) A Commentary on Uniform Use, 4. Aufl. Wiley-Blackwell, London

    Google Scholar 

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Beckmann, M., Schulmeyer, C.E., Koch, M.C., Günthert, A. (2019). Vulvakarzinom: onkochirurgische Therapie und rekonstruktive Möglichkeiten. In: Mirastschijski, U., Remmel, E. (eds) Intimchirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-57392-1_14

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  • DOI: https://doi.org/10.1007/978-3-662-57392-1_14

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