Wide local excision (WLE) for vaginal intraepithelial neoplasia (VAIN)

Background To assess the use of wide local excision in the treatment of VAI N. Methods. A retrospective review on 40 WLE procedures for VAIN. Results. The mean age was 60 years. Thirty-six (90%) patients had previous treatment for genital tract cancer or pre-cancer. The median duration and b lood loss during operation was 45 minutes and 50 mis: respectively. Fifteen complications affected 11 patients. Only one of five patients with 'vagina l cancer" was diagnosed prior to WLE. Of the 35 patients treated for VAIN 3 , 12 (34%) developed abnormal cytology during follow up - three had residua l VAIN 3, five had recurrent VAIN 3 and four had invasive cancer diagnosed. The remaining 23 (66%) patients were disease free at a median follow up of 44 months. Conclusions. Ablative therapy for VAIN 3 is unsafe as occult invasive foci can be missed by biopsy. WLE is efficacious in treating high grade VAIN 3. Long term surveillance of the lower genital tract is needed to diagnose met achronous lesions.