Surgical treatment of invasive vulvar cancer

Abstract

This paper presents the surgical treatment of invasive cancer of the vulva at the Department of Gynecology and Obstetrics inNovi Sad in the period from 2000 to 2010. Forty-one patients underwent different surgical procedures depending on their stage of the disease, age and general physical condition assessed according to the International Federation of Gynecologists and Obstetricians: wide excision to the healthy area with negative edges of 10 mm, simplex--radical vulvectomy or hemivulvectomy, block dissection of the vulva by Way, one-sided or bilateral lymphadenectomy and skin-muscle flap to cover the resulting skin defects. The number of removed lymph nodes on one side ranged from 8 to 19, the average being 12.6. Various postoperative complications (inflammation and wound dehiscence, lymphorrhoea, lymphocyst and limb lymphedema) developed in 9 (21.9%) and the local regional recurrence was recorded in 7 (17%) patients. The outcome was lethal in 4 (9.8%) surgically treated women. The primary surgical procedure is always individually planned and the choice of individual plans depends on three main factors: the size and position of the primary tumor in relation to the center line of the vulva (clitoral area--anus) and the involvement of regional lymph nodes. In order to reduce the psychosexual morbidity the preference is nowadays widely given to the local excision with adequate and histopathologically confirmed negative edges of the tumor together with determining the presence of metastases in sentinel lymph nodes.