Complications and risk factors in vulvar cancer surgery – A population-based study

Claudia Adok,Katja Stenström Bohlin,Camilla Rahm,Pernilla Dahm-Kähler

doi:10.1016/j.ejso.2022.02.006

Claudia Adok, Katja Stenström Bohlin + Show 2 more

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https://doi.org/10.1016/j.ejso.2022.02.006

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Abstract

IntroductionPrimary surgery for vulvar cancer has become less radical in past decades. This study investigates risk factors and prevalence of short-and long-term complications after up-to-date vulvar cancer surgery. MethodsPopulation-based cohort study of surgically treated primary vulvar cancer at a national center of vulvar cancer, assessing surgical outcome. The Swedish Quality Registry for Gynecological Cancer was used for identification, journals reviewed and surgical outcome including complications within 30 days and one year registered. Multivariable logistic regression analysis comprising risk factors of short-term complications; age>80 years, BMI, smoking, diabetes, lichen sclerosus and FIGO stage was performed. Results182 patients were identified, whereas 55 had vulvar surgery only, 53 surgery including sentinel lymph node biopsy (SLNB) and 72 surgery including inguinofemoral lymphadenectomy (IFL), with short-term complication rates of 21.8%, 39.6% and 54.2% respectively. Vulvar wound dehiscence was reported in 6.0% and infection in 13.7%. Complication rates were lower after SLNB than IFL (wound dehiscence 0% vs 8.3%; p = 0.04, infection 15.1% vs 36.1%; p = 0.01 and lymphocele 5.7% vs 9.7%; p = 0.52). Severe complications were rare. Persisting lymphedema evolved in 3.8% after SLNB and in 38.6% after IFL (p = 0.001), ubiquitous after adjuvant radiotherapy. In multivariable regression analysis, no associations between included risk factors and complications were found. ConclusionSurgical complications are still common in vulvar cancer surgery and increase with the extent of groin surgery. To thrive for early diagnosis and to avoid IFL seem to be the most important factors in minimizing short-and long-term complications.

Highlights

Primary surgery for vulvar cancer has become less radical in past decades
Surgery is the international standard of care and includes resection of the vulvar tumor and uni- or bilateral inguinofemoral lymphadenectomy (IFL)
This retrospective population-based cohort study identified, using the Swedish Quality Registry for Gynecologic cancer (SQRGC), all patients diagnosed with primary vulvar cancer who underwent surgery at the Sahlgrenska University Hospital between October 2012 and December 2018

Summary

Introduction

This study investigates risk factors and prevalence of short-and long-term complications after up-to-date vulvar cancer surgery. Results: 182 patients were identified, whereas 55 had vulvar surgery only, 53 surgery including sentinel lymph node biopsy (SLNB) and 72 surgery including inguinofemoral lymphadenectomy (IFL), with shortterm complication rates of 21.8%, 39.6% and 54.2% respectively. Vulvar cancer is a rare disease yearly affecting 45 000 women globally and represents 5% of gynecological malignancies [1] It is mainly seen among elderly women with a median age at diagnosis of 72 years [2]. Several attempts have been made to identify factors that can reduce treatment related morbidity of groins complications such as prophylactic antibiotics, avoiding the ligation of vena saphena magna, the replacement of metallic clips for sutures and the utilization of prolonged drainage, with conflicting results [9]. The prevalence of complications in the vulvar region after cancer surgery is not well documented in recent years

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