title: Laser-skinning colpectomy for extended vaginal intraepithelial neoplasia and microinvasive cancer.
abstract: OBJECTIVE
  The aim of this study is to analyze the efficacy of colposcopic-guided laser-skinning colpectomy to treat extended high-grade vaginal intraepithelial neoplasia (VaIN).
  
  
  METHODS
  Retrospective review of 33 heavily pretreated patients with high-grade VaIN extending over 20-100% of the vaginal surface treated between 2003 and 2013 with colposcopic-guided laser-skinning colpectomy. The vaginal epithelium including all VaIN lesions was excised in one piece with a depth of 2-3mm.
  
  
  RESULTS
  Vaginal cancer was diagnosed in 10 patients (nine microinvasive squamous cell carcinoma and one vaginal carcinoma). No serious adverse events related to laser-skinning colpectomy were observed. Of 33 patients, 23 were followed up with cytology and colposcopy for at least 12months at our institution (median follow 26.5months; range 12-104months), while five had a shorter follow-up, four an external follow-up and one patient was lost. Of 23 patients with follow-up ≥12months, 20 were disease free after a single laser-skinning colpectomy (overall cure rate 87.0%). Moderate shortening of the vagina was observed in two patients and another two required reconstruction of vaginal strictures during long-term follow-up.
  
  
  CONCLUSIONS
  Laser-skinning colpectomy appears to be a feasible treatment for extended high-risk VaIN3. The procedure avoids the mutilation associated with colpectomy and allows early diagnosis and staging of invasive disease.
authors.affiliation: Department of Gynecology, Obstetrics and Gynecologic Oncology, Klinikum Wolfsburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Luyten
authors.affiliation: Department of Gynecology, Obstetrics and Gynecologic Oncology, Klinikum Wolfsburg, Germany.
authors.forename: Hana
authors.initials: H
authors.lastname: Hastor
authors.affiliation: Department of Gynecology, Obstetrics and Gynecologic Oncology, Klinikum Wolfsburg, Germany.
authors.forename: Teodora
authors.initials: T
authors.lastname: Vasileva
authors.affiliation: Institute of Pathology, Klinikum Wolfsburg, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Zander
authors.affiliation: Department of Gynecology, Obstetrics and Gynecologic Oncology, Klinikum Wolfsburg, Germany. Electronic address: gyn@klinikum.wolfsburg.de.
authors.forename: Karl Ulrich
authors.initials: KU
authors.lastname: Petry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D014621:Vagina / Q000473:pathology / Q000601:surgery*; D014625:Vaginal Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Colposcopic-guided laser-skinning colpectomy; Treatment; Vaginal intraepithelial neoplasia