Feasibility and efficacy of vaginectomy for patients with vaginal vault high-grade squamous intraepithelial lesion after hysterectomy: a retrospective analysis of 52 cases

Objective: Vaginal vault high-grade squamous intraepithelial lesion (HSIL) after hysterectomy is sometimes seen and the treatment is tricking. We retrospectively analyzed the feasibility and efficacy of vaginectomy in these cases. Methods: Fifty-two cases diagnosed with vaginal HSIL after hysterectomy underwent partial or total hysterectomy in our hospital with complete follow-up were included. The patients’ demographics, perioperative profiles, pathological findings, human papilloma virus (HPV) infection and postsurgical changes as well as long-term outcomes were collected and analyzed. Results: Both partial and total vaginectomy could be performed in these patients with acceptable blood loss (range: 5-1500 mL), operation time (range: 23-580 minutes) and low incidence of postoperative complications (5.77%). Postoperative pathological examinations found 15 cases were with invasive carcinoma. After surgery, there was a decrease in the positive rate of HPV infection. The recurrence rate (15.38%) was low during the follow-up. There was no significant difference between patients with partial vaginectomy and those with total vaginectomy in operation time (P=0.149), recurrence (P=0.870) or the median time to HPV negativity (P=0.660). Total vaginectomy was associated with more estimated blood loss compared with partial vaginectomy (P=0.016). Conclusion: Vaginectomy for vaginal HSIL after hysterectomy was necessary and feasible. Both partial and total vaginectomies were related with low incidence of recurrence and reduced HPV positivity.