Jason K. W. Yap

Vulval Flap Reconstruction in Women With Benign, Preneoplastic and Malignant Vulval Conditions: A Prospective Study

ABSTRACTObjectivesTo (i) evaluate the surgical morbidity, (ii) identify correlates of these and, (iii) explore whether flap reconstruction following vulvectomy improves patient symptoms and quality of life.DesignSingle arm prospective study.SettingSingle tertiary vulval centre, UK.PopulationConsecutive cases of women undergoing radical vulvectomy and flap reconstructions for benign and (pre)invasive vulval conditions.MethodsProspective data collection from April 2020–February 2024. All women were given two validated questionnaires preoperatively and at 3‐, 6‐ and 12‐months to evaluate their satisfaction with the aesthetic, genitourinary and psychosexual outcomes.Main Outcome MeasuresEarly and late complications within 30 days. Patient reported outcome measures preoperatively and post‐reconstruction.Results136 flaps in 69 women were analysed. 92.6% (126/136) and 83.1% (113/136) flaps developed none‐to‐mild complications at 7 days, and between days 8 to 30, respectively. Five necrotic flaps in two patients were surgically debrided. All flaps had healed/healing at 30 days. We did not identify any correlates of complications. At 12 months, women reported an improvement in genital symptoms (p < 0.001). 80.4% (37/46) reported no urinary incontinence vs. 48.1% (26/54) preoperatively, p = 0.0038. 24.4% (11/45) were sexually active vs. 9.3% (5/54) preoperatively, p = 0.0410. More women felt attractive (p = 0.0498), were satisfied with their body (p = 0.0407) and comfortable in intimate situations (p = 0.0273). 88.9% (40/45) stated that reconstruction helped with acceptance of their cancer diagnosis and surgery.ConclusionsLocoregional flap reconstruction has low surgical morbidity, leads to a significant improvement in genitourinary and psychosexual functions. In women with cancer, reconstruction supports women to cope with their diagnosis.

Sinecatechins ointment as a potential novel treatment for usual type vulval intraepithelial neoplasia: a single‐centre double‐blind randomised control study

ObjectiveTo compare the safety and efficacy of 10% sinecatechins (Veregen®) ointment against placebo in the treatment of usual type vulvar intraepithelial neoplasia (uVIN).DesignA Phase II double‐blind randomised control trial.SettingA tertiary gynaecological oncology referral centre.PopulationAll women diagnosed with primary and recurrent uVIN.MethodsEligible patients were randomised 1:1 to receive either sinecatechins or placebo ointment (applied three times daily for 16 weeks) and were followed up at 2, 4, 8, 16, 32 and 52 weeks.Main outcome measuresThe primary outcome measure, recorded at 16 and 32 weeks, was histological response (HR). Secondary outcome measures included clinical (CR) response, toxicity, quality of life and pain scores.ResultsThere was no observed difference in HR between the two arms. However, of the 26 patients who were randomised, all 13 patients who received sinecatechins showed either complete (n = 5) or partial (n = 8) CR, when best CR was evaluated. In placebo group, three patients had complete CR, two had partial CR, six had stable disease and two were lost to follow up. Patients in the sinecatechins group showed a statistically significant improvement in best observed CR as compared with the placebo group (P = 0.002). There was no difference in toxicity reported in either group.ConclusionAlthough we did not observe a difference in HR between the two treatment arms, we found that 10% sinecatechins application is safe and shows promise in inducing clinical resolution of uVIN lesions and symptom improvement, thus warranting further investigation in a larger multicentre study.Tweetable abstractA randomised control study indicating that sinecatechins ointment may be a novel treatment for uVIN.

The role of preoperative computerized tomography (CT) scan of the pelvis and groin in the management of clinically early staged vulva squamous cell carcinoma

Vulvar squamous cell carcinoma (VSCC) commonly metastasises through groin lymphatics. However, the use of pre-operative imaging in detecting inguinal nodal metastasis before staging surgery or to triage patients for sentinel node biopsy remains unclear. Here, we investigated if pre-operative CT scan, the imaging choice in our cancer centre, influences the overall course of VSCC management in those patients without clinical evidence of groin lymphadenopathy. The study comprised of a prospective cohort of 225 patients with VSCC who underwent staging surgery within a regional tertiary gynaecological cancer centre. Comprehensive information of the cohort's demography, clinicopathological variables and outcome data were collected and analysed. Findings of pre-operative imaging were compared with histological findings of inguinal lymph nodes following groin lymphadenectomy. Statistical analyses were performed using SPSS V24. Pre-operative CT scan was performed on 116 (56.6%) patients. The sensitivity and specificity of cross-sectional imaging in detecting groin lymphatic metastasis were 59.1% and 77.8%, respectively; while the positive (PPV) and negative predictive value (NPV) were 61.9% and 75.7%, respectively. In patients who had sentinel inguinal nodes biopsy, the sensitivity, specificity, PPV and NPV of CT scan in detecting inguinal node metastasis were 30.0%, 85.7%, 33.3% and 83.7%, respectively. There was no difference in disease-free and overall survival in those who received pre-operative imaging when compared to those who did not. Pre-operative CT scan may be omitted in early stage VSCC prior to surgical staging as it does not affect overall management and surgical outcomes.