The need for screening recommendations after intestinal vaginal replacement: a systematic review of the literature.

PURPOSE: To investigate the occurrence, presentation, management, and treatment of patients found to have a primary colorectal malignancy arising in the intestinal neovagina.

METHODS

A systematic review of primary research studies describing intestinal malignancy arising in an intestinal neovagina was conducted. Reports of extraintestinal malignancy and secondary research study designs were excluded.

RESULTS

Sixteen case reports were identified over 35 years. Patients commonly had sigmoid (n = 11, 69%) neovaginas. Indications for vaginal reconstruction included Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome (n = 5, 31%), gynecologic carcinoma (n = 3, 19%), vaginal agenesis (n = 5, 31%) and cloaca (n = 3, 19%). Symptom onset ranged from 7 to 53 years after reconstruction. Age at diagnosis ranged from 17 to 53 years. Bleeding was the most common presenting symptom (n = 12, 73%). Fifty percent of patients presented with local disease (n = 8), 31% with locoregional (n = 5) and 6% with metastasis (n = 1). Treatment varied with most patients undergoing surgical resection. Survival was reported for 10 patients, half of which experienced disease recurrence. Surveillance plans were rarely described.

CONCLUSION

Adenocarcinoma in intestinal neovaginas is a rare but life-threatening disease that lacks routine screening, management and surveillance guidelines. Our findings underscore the variability in management of these patients, and the morbidity of the disease. Work to develop formalized screening guidelines is ongoing.