Laser Excisional Treatment for Vaginal Intraepithelial Neoplasia to Exclude Invasion: What Is the Risk of Complications?

Francesco Sopracordevole, Lorenzo Moriconi, Jacopo Di Giuseppe, Lara Alessandrini, Elvia Del Piero, Giorgio Giorda, Monica Buttignol, Giovanni De Piero, Vincenzo Canzonieri, Andrea Ciavattini

Research output: Contribution to journalArticle

Abstract

Objective We undertook a retrospective analysis of the incidence of complications of carbon dioxide (CO2) laser excision for high-grade vaginal intraepithelial neoplasia (HG-VaIN). Materials and Methods Retrospective large case series on 128 CO2 laser excisions for HG-VaIN in 106 women treated at the Department of Gynecologic Oncology, Oncologic Referral Center, Aviano, Italy. These procedures were performed under local anesthesia with a 20-W continuous laser beam focused to a 0.2-mm spot size. Complications were defined as "minor" when limited to vagina, and "major" when surrounding organs were injured or the vaginal vault was opened. To identify possible factors associated with surgical complications, we performed a univariate analysis with the t test for continuous variables and χ2 or Fisher exact test for qualitative variables as appropriate. Results The overall rate of complication was 7.8% (10/128); nine of them were vaginal bleeding, and only one (0.8%) was a major complication with vaginal vault perforation. A greater number of previous destructive treatments and of two or more previous laser vaginal excisional treatments was present in patients with complications compared with ones without complications (10% vs 3.9 %, p =.92, and 30% vs 15.2%, p =.44, respectively), although these differences were not statistically significant. A total of 10.5% (6/57) of occult vaginal cancer was detected in women with initial diagnosis of VaIN3 (HG-VaIN) on biopsy. Conclusions Carbon dioxide laser excision for HG-VaIN seems to be a safe approach with low rate of complications, probably because of the better accuracy achieved by CO2 laser resections, and permits diagnosis of occult invasive disease.

Original languageEnglish
Pages (from-to)311-314
Number of pages4
JournalJournal of Lower Genital Tract Disease
Volume21
Issue number4
DOIs
Publication statusPublished - Oct 1 2017

Fingerprint

Gas Lasers
Lasers
Neoplasms
Vaginal Neoplasms
Therapeutics
Uterine Hemorrhage
Vagina
Local Anesthesia
Italy
Referral and Consultation
Biopsy
Incidence

Keywords

  • laser CO
  • laser excisional treatment
  • occult cancer
  • surgical complications
  • vaginal cancer
  • vaginal excision
  • VaIN

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Laser Excisional Treatment for Vaginal Intraepithelial Neoplasia to Exclude Invasion : What Is the Risk of Complications? / Sopracordevole, Francesco; Moriconi, Lorenzo; Di Giuseppe, Jacopo; Alessandrini, Lara; Del Piero, Elvia; Giorda, Giorgio; Buttignol, Monica; De Piero, Giovanni; Canzonieri, Vincenzo; Ciavattini, Andrea.

In: Journal of Lower Genital Tract Disease, Vol. 21, No. 4, 01.10.2017, p. 311-314.

Research output: Contribution to journalArticle

Sopracordevole, Francesco ; Moriconi, Lorenzo ; Di Giuseppe, Jacopo ; Alessandrini, Lara ; Del Piero, Elvia ; Giorda, Giorgio ; Buttignol, Monica ; De Piero, Giovanni ; Canzonieri, Vincenzo ; Ciavattini, Andrea. / Laser Excisional Treatment for Vaginal Intraepithelial Neoplasia to Exclude Invasion : What Is the Risk of Complications?. In: Journal of Lower Genital Tract Disease. 2017 ; Vol. 21, No. 4. pp. 311-314.
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abstract = "Objective We undertook a retrospective analysis of the incidence of complications of carbon dioxide (CO2) laser excision for high-grade vaginal intraepithelial neoplasia (HG-VaIN). Materials and Methods Retrospective large case series on 128 CO2 laser excisions for HG-VaIN in 106 women treated at the Department of Gynecologic Oncology, Oncologic Referral Center, Aviano, Italy. These procedures were performed under local anesthesia with a 20-W continuous laser beam focused to a 0.2-mm spot size. Complications were defined as {"}minor{"} when limited to vagina, and {"}major{"} when surrounding organs were injured or the vaginal vault was opened. To identify possible factors associated with surgical complications, we performed a univariate analysis with the t test for continuous variables and χ2 or Fisher exact test for qualitative variables as appropriate. Results The overall rate of complication was 7.8{\%} (10/128); nine of them were vaginal bleeding, and only one (0.8{\%}) was a major complication with vaginal vault perforation. A greater number of previous destructive treatments and of two or more previous laser vaginal excisional treatments was present in patients with complications compared with ones without complications (10{\%} vs 3.9 {\%}, p =.92, and 30{\%} vs 15.2{\%}, p =.44, respectively), although these differences were not statistically significant. A total of 10.5{\%} (6/57) of occult vaginal cancer was detected in women with initial diagnosis of VaIN3 (HG-VaIN) on biopsy. Conclusions Carbon dioxide laser excision for HG-VaIN seems to be a safe approach with low rate of complications, probably because of the better accuracy achieved by CO2 laser resections, and permits diagnosis of occult invasive disease.",
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AU - Sopracordevole, Francesco

AU - Moriconi, Lorenzo

AU - Di Giuseppe, Jacopo

AU - Alessandrini, Lara

AU - Del Piero, Elvia

AU - Giorda, Giorgio

AU - Buttignol, Monica

AU - De Piero, Giovanni

AU - Canzonieri, Vincenzo

AU - Ciavattini, Andrea

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N2 - Objective We undertook a retrospective analysis of the incidence of complications of carbon dioxide (CO2) laser excision for high-grade vaginal intraepithelial neoplasia (HG-VaIN). Materials and Methods Retrospective large case series on 128 CO2 laser excisions for HG-VaIN in 106 women treated at the Department of Gynecologic Oncology, Oncologic Referral Center, Aviano, Italy. These procedures were performed under local anesthesia with a 20-W continuous laser beam focused to a 0.2-mm spot size. Complications were defined as "minor" when limited to vagina, and "major" when surrounding organs were injured or the vaginal vault was opened. To identify possible factors associated with surgical complications, we performed a univariate analysis with the t test for continuous variables and χ2 or Fisher exact test for qualitative variables as appropriate. Results The overall rate of complication was 7.8% (10/128); nine of them were vaginal bleeding, and only one (0.8%) was a major complication with vaginal vault perforation. A greater number of previous destructive treatments and of two or more previous laser vaginal excisional treatments was present in patients with complications compared with ones without complications (10% vs 3.9 %, p =.92, and 30% vs 15.2%, p =.44, respectively), although these differences were not statistically significant. A total of 10.5% (6/57) of occult vaginal cancer was detected in women with initial diagnosis of VaIN3 (HG-VaIN) on biopsy. Conclusions Carbon dioxide laser excision for HG-VaIN seems to be a safe approach with low rate of complications, probably because of the better accuracy achieved by CO2 laser resections, and permits diagnosis of occult invasive disease.

AB - Objective We undertook a retrospective analysis of the incidence of complications of carbon dioxide (CO2) laser excision for high-grade vaginal intraepithelial neoplasia (HG-VaIN). Materials and Methods Retrospective large case series on 128 CO2 laser excisions for HG-VaIN in 106 women treated at the Department of Gynecologic Oncology, Oncologic Referral Center, Aviano, Italy. These procedures were performed under local anesthesia with a 20-W continuous laser beam focused to a 0.2-mm spot size. Complications were defined as "minor" when limited to vagina, and "major" when surrounding organs were injured or the vaginal vault was opened. To identify possible factors associated with surgical complications, we performed a univariate analysis with the t test for continuous variables and χ2 or Fisher exact test for qualitative variables as appropriate. Results The overall rate of complication was 7.8% (10/128); nine of them were vaginal bleeding, and only one (0.8%) was a major complication with vaginal vault perforation. A greater number of previous destructive treatments and of two or more previous laser vaginal excisional treatments was present in patients with complications compared with ones without complications (10% vs 3.9 %, p =.92, and 30% vs 15.2%, p =.44, respectively), although these differences were not statistically significant. A total of 10.5% (6/57) of occult vaginal cancer was detected in women with initial diagnosis of VaIN3 (HG-VaIN) on biopsy. Conclusions Carbon dioxide laser excision for HG-VaIN seems to be a safe approach with low rate of complications, probably because of the better accuracy achieved by CO2 laser resections, and permits diagnosis of occult invasive disease.

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