RSS Channels IndexModified Radical Vulvar Surgery: Fewer Complications
MODIFIED RADICAL SURGERY OF THE VULVA FOUND TO HAVE FEWER COMPLICATIONS
CHICAGO, OCTOBER 30, 1998- Due to the psychosexual consequences and significant morbidity associated with the standard radical vulvectomy procedure, there has been a trend toward vulvar conservation in the management of women with vulvar cancer. This newer approach raises the question of whether modified radical vulvar surgery (partial removal of less than entire vulva), has reduced the complications while preserving the excellent disease free survival and low recurrence rates seen with the more radical approach.
According to a study in the October issue of Gynecologic Oncology, the scientific journal of the Society of Gynecologic Oncologists, (SGO), the appropriateness of vulvar conservation is explored. "Primary Squamous Cell Cancer of the Vulva: Radical versus Modified Radical Vulvar Surgery" was conducted by Javier F. Magrina, M.D. and Jeffrey Cornella, Department of Obstetrics and Gynecology, Mayo Clinic, Scottsdale, Arizona; Amy Weaver, Section of Biostatistics; Thomas A. Gaffey, M.D., Division of Anatomic Pathology; Maurice J. Webb, M.D., and Karl C. Podratz, M.D., Section of Gynecologic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; Jesus Gonzalez-Bosquet, Hospital vall D'Hebron, Barcelona, Spain.
Background: Surgical treatment of the vulva has become individualized in recent years, depending on the location and size of the cancerous lesion. Vulvar cancer accounts for 4% of all gynecologic cancers and the American Cancer Society estimates that 3,200 cases will be diagnosed this year. The classic radical vulvectomy has been recently replaced with more conservative types of vulvar operations such as the following: wide local excision; removal of only the skin that contains the cancer; removal of the entire vulva but no lymph nodes; and, partial vulvectomy, the removal of less than the entire vulva.
Methodology: Between January 1, 1976 and December 31, 1990, a retrospective review of 225 patients with vulvar cancer was conducted. Clinical, pathologic, surgical, and follow-up data were collected from the patient records and all pathology slides were reviewed by the same pathologist. Of the 225 patients, 134 patients had radical surgery; modified radical surgery accounted for 91 patients, 65 of these patients had vulvar excision alone, and the remaining 26 had, in addition, lymph node removal via separate groin incision.
Results: The results of both types of surgery in the 225 patients (mean age 68.2 years) showed:
-- Cancerous groin recurrences after lymphadenectomy were noted in 4 of 134 patients in the radical vulvar surgery group and in 2 of 26 patients in the modified radical surgery group.
-- Subsequent cancerous groin node growth developed in 5 of the 78 patients, 65 with vulvar excision alone; 13 with additional unilateral lymphadenectomy. By study definition, the latter group had modified radical surgery. Metastasis alone occurred in 6 of 134 patients in the radical surgery group and in none of the modified radical surgery group. Development of both groin and distant metastasis occurred in only 3 patients treated by the modified radical surgery.
-- Surgical complications were noted in 19 patients (20.9%) in the modified radical group and in 80 patients (59.7%) in the radical group. Vulvar complications occurred in 7 of 65 patients (10.8%) with vulvar excision, in 3 of 26 patients (11.5%) in the modified radical surgery group and in 49 of 134 patients (36.6%) in the radical surgery group.
Conclusion: Modified radical vulvar surgery is associated with decreased complications and improved five year overall disease-free rates compared to those of radical vulvar surgery.
"As was done with breast cancer treatment, we are refining our procedures and have determined that a more conservative surgery is best for most women who develop vulvar cancer. Our goal is to cure this disease while still allowing patients to lead happy and healthy lives," says Karl C. Podratz, SGO President and Director of the Department of Gynecologic Oncology at the Mayo Clinic.
Gynecologic Oncology is published by Academic Press and is the scientific journal of the Society of the Gynecologic Oncologists (SGO). SGO is the only United States Medical organization dedicated to the prevention, detection, and cure of female cancers. More information about gynecologic cancer is available on the Internet at www.sgo.org. or www.wcn.org.
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Editor's Note: For the full abstract of this study or questions, contact Johanna Spangenberg at (703) 527-7424 or jmsdc@aol.com
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