Wide local excision of the vulva for premalignant or benign lesions: are there differences in outcomes between gynecologic oncologists and general gynecologists?

Abstract

Objectives: To describe outcomes following wide local excision (WLE) of the vulva for suspected premalignant or benign disease at a tertiary care center over the years 2016 to 2020. To determine differences in the rates of wound complications and positive margins between patients treated by gynecologic oncologists (GO) and those treated by general gynecologic (GYN) surgeons. Methods: Consecutive patients were identified who underwent wide local excision of the vulva for suspected premalignant or benign lesions between June 1, 2016 and February 28, 2020. Institutional Review Board (IRB) approval was obtained and surgical records were reviewed; patients undergoing “wide local excision, vulva,” “simple partial vulvectomy,” or “destruction of vulvar lesion with excision” were considered for inclusion. Demographic, peri- and postoperative, and pathologic data were collected, and patients were separated by surgeon division (GO or GYN). Patients had follow up documented at least through the postoperative appointment. Surface areas of elliptical specimen were calculated using ‘0.25 x length x width x pi.’ Wound complications and other variables were compared between these groups. All eligible patients were included in the analysis of wound complications. Only patients with pathologic diagnoses of vulvar dysplasia were included in the analysis of margin positivity. Fisher's exact tests and Chi squared tests were used to compare categorical variables and logistic regression models were used for continuous variables. P-values Results: Three-hundred thirty-five patients met inclusion criteria over the study period (GO, n=223; GYN, n=112). Patients in the GO group were older (median age 56y versus 40.5y, P 0.5), or hematoma (1% vs 2%, P>0.5). More patients in the GO group had pathology of high-grade vulvar dysplasia (HSIL) with or without occult carcinoma at the time of WLE (77% vs 40%, P Conclusions: There is renewed interest in optimal management of vulvar surgery.[1] WLE is a common procedure done by GO and GYN surgeons. In our study there was a high overall rate (42%) of postoperative wound complication; however, there were no significant differences in complication rates between GO and GYN surgeons. The rate of positive margins following WLE for vulvar dysplasia was also similar between these groups. The trend towards more frequent complications among GO patients may be explained by a population with older age and more comorbidities. It is appropriate for GO or GYN surgeons to perform WLE of the vulva for HSIL, provided the necessary expertise, comfort, and low concern for invasive disease requiring radical excision or lymph node dissection.