Reducing the radicality of surgery for vulvar cancer: are smaller margins safer?

Milliken, Sarah; May, James W.; Sanderson, Peter; Congiu, M; D’Oria, Ottavia; D’Augè, Tullio Golia; Caruso, Giuseppe; Donato, Violante Di; Panici, Pierluigi Benedetti; Giannini, Andrea

doi:10.23736/s2724-606x.20.04743-7

Cited by 19 publications

(17 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The intermediate margins value (2–8 mm) was not a predictor of local recurrence 32,33 . The use of re‐excision or adjuvant radiotherapy on the basis of close surgical margins alone (2–8 mm) should be carefully considered 27 . Höckel et al proposed a novel approach for patients with vulvar cancer based on compartmental tumor spread and based on ontogenetic anatomy: in this prospective trial patients were treated with vulvar field resection and anatomical reconstruction, considering anatomy from embryonic development.…”

Section: Results: Surgical Treatmentmentioning

confidence: 99%

“…There are situations where close margins are more common (proximity to the clitoris, urethra, or vulva), but the National Comprehensive Cancer Network (NCCN) Guidelines recommend re‐excision of positive margins or those classified as close (<8 mm) 26 . If smaller margins are safe is subject of studies 27 …”

Section: Results: Surgical Treatmentmentioning

confidence: 99%

“…26 If smaller margins are safe is subject of studies. 27 Moreover, postoperative reconstruction, based on patients' characteristics, after demolitive surgeries has improved esthetic result and psychological acceptance of this pathology, representing an important step for personalized treatment. Two types of flaps were identified: Advancement Flap (V-Y Gluteal Fold Flap; Medial Thigh Flap) and Transpositional Flap (Lotus Petal Flap; Gluteal Thigh Flap; Gluteal Fold Flap and Anterolateral Thigh Flap).…”

Section: Surgical Managementmentioning

confidence: 99%

“…32,33 The use of re-excision or adjuvant radiotherapy on the basis of close surgical margins alone (2-8 mm) should be carefully considered. 27 Höckel et al proposed a novel approach for patients with vulvar cancer based on compartmental tumor spread and based on ontogenetic anatomy: in this prospective trial patients were treated with vulvar field resection and anatomical reconstruction, considering anatomy from embryonic development. The extent of deep vulvar resection is not defined with conventional surgical margins and this approach allows to preserve tissue for esthetic reconstruction.…”

Section: Resection Marginsmentioning

confidence: 99%

See 3 more Smart Citations

The giant steps in surgical downsizing toward a personalized treatment of vulvar cancer

Giannini¹,

D’Oria²,

Chiofalo³

et al. 2021

J of Obstet and Gynaecol

Self Cite

View full text Add to dashboard Cite

The present article aims to highlight the importance of changes of personalized surgical treatment for vulvar cancer. Current international literature regarding surgical treatment of vulvar cancer was evaluated. This included several studies and systematic reviews. Radical surgery approach, such as en bloc resection, was the first therapeutic option and the standard care for many years, even if burdened with a high complication rate and frequently disfiguring. Taussing and Way introduced radical vulvectomy approach with en bloc bilateral inguinal‐femoral lymphadenectomy; modified radical vulvectomy was developed, with a wide radical excision of the primary tumor. The role of inguinofemoral lymphadenectomy (mono or bilateral) changed in the years too, particularly with the advent of SLN biopsy as minimally invasive surgical approach for lymph node staging, in patients with unifocal cancer <4 cm, without suspicious groin nodes. More personalized and conservative surgical approach, consisting of wide local or wide radical excisions, is necessary to reduce complications as lymphedema or sexual disfunction. The optimal surgical management of vulvar cancer needs to consider dimensions, staging, depth of invasion, presence of carcinoma at the surgical margins of resection and grading, with the goal of making the treatment as individualized as possible.

show abstract

Section: Results: Surgical Treatmentmentioning

confidence: 99%

Section: Results: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Managementmentioning

confidence: 99%

Section: Resection Marginsmentioning

confidence: 99%

See 2 more Smart Citations

The giant steps in surgical downsizing toward a personalized treatment of vulvar cancer

Giannini¹,

D’Oria²,

Chiofalo³

et al. 2021

J of Obstet and Gynaecol

Self Cite

View full text Add to dashboard Cite

show abstract

“…A big step in the personalized approach to vulvar cancer was represented by postoperative reconstruction [9,10], based on patients' characteristics and anatomy, with a big improvement of aesthetic results in these patients. The postoperative reconstruction includes two types of Flaps: Advancement Flap (V-Y Gluteal Fold Flap; Medial Thigh Flap) and Transpositional Flap (Lotus Petal Flap; Gluteal Thigh Flap; Gluteal Fold Flap and Anterolateral Thigh Flap [11,12].…”

mentioning

confidence: 99%