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Neovagina creation methods in Müllerian anomalies and risk of malignancy: insights from a systematic review

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Abstract

Purpose

This systematic review aims to provide a data synthesis about the risk of neovaginal cancer in women with Müllerian anomalies and to investigate the association between the adopted reconstructive technique and the cancer histotype.

Methods

PubMed, MEDLINE, Embase, Scopus, ClinicalTrials.gov and Web of Science databases were searched from inception to March 1st, 2023. Studies were included if: (1) only women affected by Müllerian malformations were included, (2) the congenital defect and the vaginoplasty technique were clearly reported, (3) the type of malignancy was specified.

Results

Literature search yielded 18 cases of squamous cell carcinoma and two cases of vaginal intraepithelial neoplasia 3 (VAIN 3). Of these, 3 had been operated on according to the Wharton technique, 8 according to the McIndoe technique, 3 with a split-skin graft vaginoplasty, 2 according to the Davydov technique, 2 with a simple cleavage technique, 1 according to the Vecchietti technique and 1 with a bladder flap vaginoplasty. A total of 17 cases of adenocarcinoma and 1 case of high-grade polypoid dysplasia were also described. Of these, 15 had undergone intestinal vaginoplasty, 1 had been operated on according to the McIndoe technique and 1 had undergone non-surgical vaginoplasty. Finally, 1 case of verrucous carcinoma in a woman who had undergone a split-skin graft vaginoplasty, was reported.

Conclusion

Although rare, neovaginal carcinoma is a definite risk after vaginal reconstruction, regardless of the adopted technique. Gynaecologic visits including the speculum examination, the HPV DNA and/or the Pap smear tests should be scheduled on an annual basis.

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Data availability

Data are available upon reasonable request from the corresponding author.

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Authors and Affiliations

  1. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Francesco Fedele

  2. Department of ClinicalSciences and Community Health, Università Degli Studi di Milano, Milan, Italy

    Francesco Fedele & Fabio Parazzini

  3. IRCCS Humanitas Research Hospital, Rozzano - Milan, Italy

    Alessandro Bulfoni & Andrea Busnelli

  4. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy

    Andrea Busnelli

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  1. Francesco Fedele
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Contributions

AB and FF conceived and designed the study. AB and FF independently assessed the included studies for risks of bias and graded the quality of evidence. AB and F.P evaluated all articles and extrapolated the data on a standardized form. AB and FF drafted the first version of the article. All authors revised it critically and approved the final version to be published.

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Correspondence to Andrea Busnelli.

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Fedele, F., Bulfoni, A., Parazzini, F. et al. Neovagina creation methods in Müllerian anomalies and risk of malignancy: insights from a systematic review. Arch Gynecol Obstet 309, 801–812 (2024). https://doi.org/10.1007/s00404-023-07086-6

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