Surgical Treatment Of Vulvar Cancer Research Articles

Primary groin irradiation vs primary groin surgery for early vulvar cancer.

Despite changes in technique, morbidity after surgical treatment for vulvar cancer is considerable and mainly related to the groin dissection. Primary radiotherapy to the groin is expected to result in lower morbidity. However, studies on the efficacy of primary radiotherapy for the groins in terms of groin recurrences and survival show conflicting results. To determine whether the effectiveness and safety of primary radiotherapy to the inguino-femoral lymph nodes is comparable with surgery The literature search was carried out using the criteria set by the Cochrane Gynaecological Cancer Group. A MEDLINE and EMBASE search using the Mesh Heading 'vulvar neoplasms' and textword 'vulva' was performed. Publications on the effectiveness of primary radiotherapy treatment of early squamous cell carcinoma of the vulva were selected. Randomized clinical trials, case-control and observational studies of primary radiotherapy of the groin Type of participants: Patients with early squamous cell cancer of the vulva Type of interventions: inguino-femoral lymph node dissection and primary radiotherapy of the inguino-femoral lymph nodes. Type of outcome measurements: incidence of groin recurrences, survival and morbidity Two reviewers independently assessed study quality and extracted results Out of nine reviewed papers only three met the selection criteria. From these studies, (one randomised controlled trial [RCT] one case-control and one observational study) it became clear from the RCT that the incidence of groin recurrences after primary radiotherapy is higher compared with surgery. survival was also worse in the radiotherapy group. The other two studies showed a higher than expected number of groin recurrences after primary radiotherapy. Morbidity after primary radiotherapy was lower compared with surgery. The conclusion of the RCT was criticized on the grounds of the depth of the radiotherapy administered. The depth of 3 cm used in the RCT, is too shallow to administer an optimal dose to the deeper groin nodes. As shown in an RCT, primary radiotherapy to the groin results in less morbidity but also in a higher number of groin recurrences compared with surgery. Although the technique of radiotherapy in the RCT was criticized, other uncontrolled data do not give evidence for a similar or better groin control for radiotherapy when compared to surgery. This means that surgery is still to be considered the cornerstone of therapy for the groin nodes in women with vulvar cancer. Individual patients not fit enough to withstand surgery can be treated with primary radiotherapy.

Surgical interventions for early squamous cell carcinoma of the vulva.

Radical surgery has been standard treatment for patients with early vulvar cancer since mid century. Survival figures are excellent, but complication rates are high. Over the last two decades, surgical treatment has become more individualised in order to decrease complications in patients with limited disease. To determine whether the effectiveness and safety of individualised treatment is comparable with that of more extensive (non-individualised) surgery. The cirteria set by the Cochrane Gynaecological Cancer Group were used. We searched Medline and Embase (last search on 16 November 1999) We used our own publication archives, based on a prospective handsearch of six leading relevant journalswhich was started in December 1986. Reference lists of identified studies, gynaecological cancer handbooks and conference abstracts were also used. Types of study: RCT's, case control and observational studies on the effectiveness of surgical treatment of vulvar cancer. patients with cT1N0M0 squamous cell carcinoma of the vulva. Types of interventions: local surgical treatment as well as regional lymph node dissection. Types of outcome measurements: overall, disease specific and disease free survival; treatment complications; quality of life issues. The two reviewers independently assessed study quality and extracted data. Only two studies with a total of 94 participants were included in the review. Both were observational studies. None of the other eleven considered studies met the minimum criteria as set by the Cochrane Collaboration. From these two studies, it can be concluded that: 1. radical local excision is as safe as a radical vulvectomy; 2. An ipsilateral lymph node dissection is safe in patients with a well lateralised tumour, and 3. A superficial groin node dissection is not as safe as a full femoro-inguinal groin node dissection. The fourth question we intended to answer is of great clinical importance: is the triple incision technique as safe as an en bloc dissection? This question could only be answered by using some of the unselected studies. From these studies, the triple incision technique appears to be as safe as the en bloc technique. The available evidence regarding surgical treatment of early vulvar cancer is generally of poor quality. From the evidence with sufficient quality we conclude that radical local excision, ipsilateral lymph node dissection in lateral tumors and triple incision technique are safe treatment options for early vulvar cancer. However, superficial groin node dissection results in an excess of groin recurrences compared to a full femoro-inguinal groin node dissection.

Isolated skin bridge metastasis following modified radical vulvectomy and bilateral inguinofemoral lymphadenectomy.

Separate vulvar and groin incisions have significantly reduced the morbidity of vulvar cancer surgery. We describe a patient with FIGO stage II squamous vulvar cancer, who developed an ipsilateral tumor recurrence in the skin bridge between the vulva and the groin within 7 months of modified radical vulvectomy and bilateral inguinofemoral lymphadenectomy, using triple incisions. The recurrence was treated by wide local excision alone and she remains free of disease 2 years later. Although rare, the potential for failing to excise tumor emboli in the lymphatics of the skin bridge must be recognized when the triple incision technique is used in the surgical treatment of vulvar cancer.

Lymphatic spread in carcinoma of the vulva

A study of 153 patients with squamous cell carcinoma of the vulva is reviewed. Regional node metastases were present in 20%, and lymphatic spread proved the single most significant prognostic factor in this disease. Recurrent carcinoma developed in 47% of cases with nodal metastases. Lymph node metastases were directly related to stage of disease, tumor differentiation, lesion size, and depth of invasion. Sixty percent of nodal disease was not suspected by clinical examination. No patient developing recurrent disease after identification of positive nodes survived the disease. Surgical staging based only upon size of lesion and presence of nodal metastases appears to offer a clearer prognostic profile than conventional clinical staging. The pattern and frequency of nodal spread suggest that in selected instances modifications of the standard surgical treatment of vulvar cancer may be appropriate.

Operation technique in surgical treatment of vulvar cancer.

Operation technique in surgical treatment of vulvar cancer.