Vaginal cuff recurrence after treatment for endometrial cancer is most commonly managed with radiotherapy, and there are relatively few surgical case reports. The authors present a case to illustrate a laparoscopic approach for resection of an isolated vaginal cuff recurrence, combined with pelvic lymphadenectomy, and to describe operative principles that enabled definitive en bloc resection while preserving important neural structures when appropriate.
A 57-year-old woman initially underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy for grade 1 endometrioid carcinoma, staged as FIGO IA. No adjuvant therapy was given after the primary surgery. Nine months postoperatively she was referred with suspicion for recurrence at the vaginal cuff and possible pelvic lymph node involvement.
Preoperative imaging reportedly identified a recurrent lesion at the vaginal cuff and enlarged pelvic lymph nodes. Imaging suggested no invasion of adjacent organs, and the pelvic nodes were considered surgically resectable. The abstract does not provide imaging modality details, exact lesion dimensions, or quantitative nodal size; those specifics were not reported in the source abstract.
The surgical team performed a laparoscopic resection of the vaginal cuff tumor together with pelvic lymphadenectomy. The procedure followed the established anatomical principles of radical hysterectomy to ensure adequate lateral and paravaginal margins. Key intraoperative steps described in the report included:
Because paravaginal tissue invasion was not suspected on imaging and intraoperative assessment, the surgeons preserved the hypogastric nerves. Specimens (vaginal cuff tumor and lymph nodes) were retrieved transvaginally in protective bags, a technique intended to reduce the risk of tumor spillage during specimen extraction.
The abstract does not report additional operative metrics such as total operative time, estimated blood loss, intraoperative complications, or conversion to open surgery; those details were not provided in the source.
Histopathologic examination confirmed that the excised vaginal cuff lesion was recurrent endometrioid carcinoma, upgraded to grade 3 in the recurrent specimen. Resection margins were reported as negative. Pathology also revealed pelvic nodal metastases.
Following the surgical resection, the patient received postoperative chemotherapy. The specific chemotherapy agents, dosing, number of cycles, and timing relative to surgery are not described in the abstract and therefore were not reported in the source.
The report states that the patient remained disease-free after the combined surgical and postoperative chemotherapy treatment. The abstract does not specify the length of follow-up or surveillance protocol used to determine disease-free status; those time-course details were not reported.
This single-case report supports the feasibility of a minimally invasive laparoscopic resection for selected patients with an isolated vaginal cuff recurrence of endometrial cancer, particularly when preoperative assessment indicates no adjacent organ invasion and pelvic nodes are resectable. The approach described applies the anatomical principles of radical hysterectomy to achieve negative margins while permitting nerve preservation when paravaginal invasion is absent.
Limitations inherent to the source include its single-case design and limited reporting in the abstract: operative metrics, perioperative morbidity, specific imaging modalities and measurements, detailed chemotherapy regimen, and duration of follow-up were not provided. These omissions limit generalizability and preclude direct comparison to radiotherapy-based management or other surgical strategies. Further series or comparative studies would be required to define selection criteria, oncologic outcomes, and morbidity profiles for laparoscopic resection in this setting.
In this reported case, laparoscopic excision of a vaginal cuff recurrence combined with pelvic lymphadenectomy achieved negative margins and identified nodal metastases; postoperative chemotherapy followed and the patient was reported disease-free. The authors propose that laparoscopic resection can be a valuable therapeutic option for carefully selected patients with isolated vaginal cuff recurrence after primary surgery for endometrial cancer. Specific procedural and oncologic details beyond those summarized in the abstract were not reported in the source.