A risk factor analysis of complications after surgery for vulvar cancer

V Guenther,A S Laganà,I Alkatout,Georgios Gitas,L Proppe,S Baum,D Tsolakidis,D Freytag,M Kruggel,D Zouzoulas,A Rody

doi:10.1007/s00404-020-05949-w

Abstract

IntroductionDespite the less frequent use of surgery in patients with vulvar cancer, the high rates of postoperative complications are still a matter of concern. The aim of the present study was to identify risk factors that influence postoperative complications rates in vulvar cancer and identify specific clinical parameters that may influence their incidence.MaterialsPatients who underwent curative-intent surgery for squamous cell carcinoma of the vulva from 2003 to 2018 were selected. All patient characteristics were analyzed as risk factors for the development of postoperative lymphocele, lymphedema, and wound dehiscence. The patients were followed up for 2 years postoperatively.ResultsThe investigation comprised 121 patients, of whom 18.1% developed wound dehiscence, 17.7% a lymphocele, and 20.4% lymphedema. We found no significant evidence of an association between patient’s characteristics and postoperative complications. The depth of tumor invasion and the appearance of lymph-node metastasis were significantly associated with postoperative complications. Free resection margins of 5 mm or more were associated with a reduced risk of postoperative complications compared to resection margins less than 5 mm. No complications were encountered after sentinel node biopsy (SNB). Complication rates were associated with inguinofemoral lymphadenectomy, but not with the extent of lymphadenectomy. The development of a lymphocele or wound dehiscence may be correlated with the development of long-term lymphedema.ConclusionFIGO stage at diagnosis influences the risk of postoperative complications. The use of SNB minimized postoperative complications. Correlations between the free microscopic resection margin distance and the risk of postoperative wound dehiscence must be investigated further.

Highlights

Despite the less frequent use of surgery in patients with vulvar cancer, the high rates of postoperative complications are still a matter of concern
The majority of patients (95cases) underwent an additional inguinal lymphadenectomy: sentinel node biopsy (SNB) alone was performed in 24 patients, a primary IFLND in 41, and both procedures in 30 patients
Complication rates were associated with IFLND or lymphnode metastasis, but the results did not allow to determine a threshold concerning the extent of lymphadenectomy and the risk of postoperative complications

Summary

Introduction

Despite the less frequent use of surgery in patients with vulvar cancer, the high rates of postoperative complications are still a matter of concern. All patient characteristics were analyzed as risk factors for the development of postoperative lymphocele, lymphedema, and wound dehiscence. In the 1980s, surgical treatment of vulvar cancer consisted of radical en bloc resection of the tumor with bilateral inguinofemoral lymphadenectomy (IFLND), as described by Rutledge. This concept has been rejected because of high complication rates [3]. The standard surgical procedure for the treatment of vulvar cancer is the triple incision technique (separate incisions for groin node dissection). Under specific requirements, such as a unifocal tumor less. Approximately one-half of patients with vulvar cancer need to undergo an IFLND [5]

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