Organ-Sparing Central Pelvic Compartment Resection for the Treatment of Vulvo-Vaginal Melanomas

Figures & data

Figure 1. Sagittal view of dissection planes.

Figure 2. Frontal view of dissection planes.

Figure 3. Flow diagram for literature search on surgical survivorship for vaginal melanoma.

Figure 4. Flow diagram for literature search on surgical complications following minimal access approach to gynecological oncology pelvic exenterations – all types and pathologies.

Figure 5. Vulvo-vaginal melanoma seen during clinical examination – case 3.

Figure 6. En bloc specimen using central compartment exenteration technique – case 3.

Figure 7. Postoperative laparoscopic view of pelvis – case 3.

Table 1. Patient demographics and surgical outcomes.

Parameter	Patient No.
	1		2		3
Age (years)	69		58		58
BMI (kg/m^2)	27		25		23
Co-morbidities	Hypertension		Hypertension		Nil
Organ involvement	Urethra	Complete	Urethra	Distal 1/3rd	Urethra	Distal 10 mm
	Vulva	Complete with skip lesions	Vulva	Complete with skip lesions	Vulva	Complete
	Vagina	Complete with skip lesions	Vagina	Complete with skip lesions	Vagina	Complete with skip lesions
	Cervix	Not involved	Cervix	Not involved	Cervix	Complete
Depth of invasion (mm)	>9		>9		9
Stage (T, N, M)	IIc (T4b, N0, M0)		IIb (T3b, N0, M0)		IIb (T3b, N0, M0)
Date of surgery (mm-yyyy)	02-2015		05-2017		11-2021
Closest margin (mm) (anatomical position)	8 (3 o’clock margin of vagina)		10 (9 o’clock margin of vagina)		4 (6 o’clock posterior margin vagina)
Surgical time (mins)	360		330		300
Bloods loss (mls)	400		200		150
Length of stay (days)	5		2		2
Early post-op complications (Clavien-Dindo grade)	Yes (Grade II)		No		Yes (Grade IIIa)
Late post-op complications	No		No		No
Progression-free survival (months)	6		11		–
Overall survival (months)	82		18		16 (alive)

Table 2. Literature review on surgical survivorship of vaginal melanoma.

Study	n	Median age (years)	No. treated with surgery	No. treated with radical surgery	Progression-free survival (months)	Median overall survival (months)	No. with margin involved	Ref.
Cobellis et al.	15	55	13	11	8.5	19	Not stated	[21]
Ferraioli et al.	16	61.6	9	3	11.8 (2–49)	30.4 (11–144)	3	[23]
Frumovitz et al.	37	60.6	33	4	11.4	19.1	6	[24]
Huang et al.	31	58	22	Not stated	Not stated	20.1	Not stated	[4]
Janco et al.	14	Not stated	14	6	6	25.2	Not stated	[25]
Kirschner et al.	201	68.3	141	52	Not stated	14	Not stated	[2]
Miner et al.	35	62	24	12	12	25	2	[22]
Reid et al.	15	66	13	3	Not stated	30	2	[26]

Table 3. Literature review of surgical complications with minimally invasive pelvic exenteration.

Study	No. cases	Tumor sites		Type of exenteration		Median age	Median blood loss (ml)	Operative time (min)	Length of stay (days)	Complications				Ref.
										Early		Late
										Type	n	Type	n
Bizzarri et al.	23	Cervical	10	Anterior	18	64	400	540	10	Infection	3	Infection	4	[27]
		Endometrial	9	Total	5					Urinary diversion	2	Urinary diversion	4
		Vaginal	3									Bowel	1
		Urothelial	1
Jain et al.	14	Cervical		All anterior PE		52.5	135	305	6.5	Infection	1	Infection	1	[28]
										Urinary diversion	1	Urinary diversion	1
										Bowel	4	Bowel	5
Karkia et al.	6	Cervical	1	Anterior	2	63	400	600	8	Infection	1	None		[24]
		Endometrial	2	Posterior	3					Urinary diversion	1
		Vaginal	1	Total	1
		Vulval	1							Wound problems	1
		Bartholin’s	1
Martínez et al.	14	Cervical	7	Anterior	8	72	400	339	26.5	Urinary diversion	5	Urinary diversion	4	[29]
		Uterine	1	Posterior	3					Bowel	4	Bowel	0
		Vulvar	4	Total	3
		Urethral	1							Wound problems	4	Wound problems	2
		Rectal	2
Nguyen Xuan et al.	5	All cervical		Anterior	3	58.5	Not stated	402	11.5	Infection	5	Urinary diversion	1	[25]
				Posterior	1							Bowel	1
				Total	1							Wound problems	1
Puntambekar et al.	74	All cervical		All anterior		50	160	180	6	Infection	9	Infection	1	[30]
										Urinary diversion	2	Urinary diversion	2
												Bowel	3

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