Vulvar field resection: Novel approach to the surgical treatment of vulvar cancer based on ontogenetic anatomy

Abstract

Objective Current local treatment of vulvar cancer is wide tumor excision and radical vulvectomy based on functional anatomy established from the adult and on the view of radial progressive tumor permeation. Standard surgery is associated with a considerable local failure rate and severe disturbance of the patients' body image. Vulvar field resection (VFR) is based on ontogenetic anatomy and on the concept of local tumor spread within permissive compartments. VFR combined with anatomical reconstruction (AR) is proposed as a new surgical approach to the treatment of vulvar cancer. Methods A prospective trial was launched to test the compartment theory for vulvar cancer and to assess safety and effectiveness of the new therapy. Results In 54 consecutive patients 46 tumors were locally confined to the tissue compartment differentiated from the vulvar anlage. The 8 tumors having transgressed into adjacent tissue compartments of different embryonic origins exhibited signs of advanced malignant progression. 38 patients with vulvar cancer, stages T1–3 were treated with VFR and AR. The perioperative complication rate was low. At 19 (3–50) months follow-up no patient failed locally. 33 patients estimated their body image as undisturbed. Conclusions Vulvar cancer permeates within ontogenetic tissue compartments and surgical treatment with VFR and AR appears to be safe and effective. Patients should benefit from the new approach as local tumor control is high and the preserved tissue can be successfully used for restoration of vulvar form and function. Confirmatory trials with more patients and longer follow-up are suggested.