Rare localization
The upper third of the vagina is drained into the pelvic nodes (the operation is similar to radical hysterectomy; with the uterus preserved, a combined volume is possible), the lower third - into the inguinal nodes (inguinal-femoral lymph node dissection). The wall defect is restored with local tissue or flaps while maintaining function. The plan is always multidisciplinary: for many stages, chemoradiotherapy is the basis, and surgery for early and residual tumors. Histology with margins and nodes determines next steps; observation - regular examinations with cytology.
Indications
- cervical cancer IA2–IIA — radical hysterectomy with pelvic lymph node dissection (Wertheim procedure);
- endometrial cancer - extirpation with appendages and lymph node dissection according to risk;
- ovarian cancer - cytoreductive interventions as part of complex treatment;
- vaginal cancer - radical removal with lymph node dissection;
- atypical hyperplasia with impossibility of organ preservation.
Principles of radical surgery
Oncological gynecological surgery differs from a conventional hysterectomy in volume: the tumor is removed with surrounding tissues (parameters, vaginal cuff) and lymphatic drainage pathways as a single block - this is the radicality that determines the prognosis. The number and condition of removed lymph nodes stages the disease and resolves the issue of postoperative radiation/chemotherapy. The price categories reflect the complexity: involvement of neighboring organs, the need for ureteral stenting, prevalence. The operations are performed by a gynecological oncology team with high-level anesthesiological support.
