Vulvar cancer: surgical management and survival trends in a low resource setting

Abstract

Background: This study aims to analyze risk factors, clinical profiles, treatment protocols, and disease outcomes in histologically proven resectable vulvar cancer (VC) patients according to tumor stage. This is a retrospective analysis of a prospectively collected database of 20 VC patients from May 2014 to June 2019. Results: The mean age of VC diagnosis was 55 years, with a range of 38-84 years. The incidence was four cases per year. The disease incidence was significantly more in post-menopausal (65%) and multiparous (90%) women. According to FIGO staging of vulvar cancer, stages I, II, and III were assigned to 6, 1, and 11 patients respectively. Two patients suffered from stage IVa vulvar melanoma. All patients had undergone surgical interventions. Patients treated with only nonsurgical (chemotherapy/radiotherapy/chemo-radiotherapy) treatment modalities were excluded from the study. Fifteen patients were treated with wide local excision (WLE), bilateral inguinofemoral dissection (B/L IFLND), and primary repair. Four and one patients were treated with radical vulvectomy (RV) and modified radical vulvectomy (MRV) [with or without B/L IFLND and PLND] respectively. Reconstruction with V-Y gracilis myocutaneous and local rotation advancement V-Y fasciocutaneous flaps were done in two patients. Therapeutic groin nodal dissection was performed in 19 patients except in one patient who was treated by palliative radical vulvectomy. In the final histopathology reports, tumor size varies from 0.5 to 6.5 cm (mean 3.35 cm) with the predominance of squamous cell carcinoma (18 out of 20 patients). Only 10 out of 18 eligible patients received adjuvant treatment. Poor patient compliance has been one of the major reasons for adjuvant treatment attrition rate. Systemic and loco-regional metastasis occurred in 3 patients each arm respectively. Poor follow up of patients is the key limitation of our study. Conclusion: Vulvar cancer incidence was significantly high in post-menopausal and multiparous women. The most important prognostic factors were tumor stage and lymph node status. Oncological resection should be equated with functional outcome. The multidisciplinary team approach should be sought for this rare gynecological malignancy.

The Unmet Needs in the Management of Vulvar Cancer and a Review of Indian Literature

“…Subsequently, Modi et al 20 showed the 2-year disease-free survival was 100% in those with no nodal involvement, 73.5% in those with unilateral nodal disease, and only 60% in those with bilateral nodal involvement. 16 The mean overall survival in our study was 61.65 months for all stages which was comparable with the studies by other authors ie, Kumar et al 11 and Singh et al 12 For patients who did not undergo GND or postoperative radiation therapy, we could not assess them for their nonrecurrence or survival, although the tumor size was more than 2 cm with a depth of stromal invasion . 2 mm.…”

Clinico-pathological Characteristics and Treatment Modalities of Vulvar Cancer: A Retrospective Analysis

“…Eke et al also found highest incidence of vulvar cancer in low socio-economic class. 12 Most (56.3%) of patients were postmenopausal which is nearly similar to the study conducted (70%) by Meelapkij et al 14 About 67.7% participants were married and 24.0% patients were widowed in the current study. Huang et al found 42.1% patients to be married and 25.2% patients widow in their study, which is also comparable to present study.…”

“…It is almost in contrary to an Indian study conducted by Kumar et al where the patients were mostly Hindu (90.0%) followed by Muslims (5.0%) and Christian (5.0%). 12 This is because of the religious preponderance of the population of particular geographical areas. Study population mostly belonged to low socio-economic class and was illiterate (58.3%).…”

“…It is also comparable to the study conducted by Kumar N et al where 90% patients were multiparous and 10% nulliparous which may be due to small the sample size. 12 The most common symptom of vulvar cancer is a long history of pruritus. Less frequently reported symptoms include vulvar bleeding, dysuria, discharge and pain al.…”

Global cancer surgery in low‐resource settings: A strengths, weaknesses, opportunities, and threats analysis

“…Studies describing the local landscape of cancer surgery burden, caseload, operative techniques, outcomes, and barriers are foundational to identifying key intervention targets and to evaluating change over time. 15,16 On a more "microscopic" level, recent studies highlighting differences in tumor pathology and epidemiology between settings have yielded important insights. [17][18][19][20][21] A study among Indian patients status-post radical cholecystectomy for gallbladder carcinoma supported the utility of evaluating lymph node involvement for determining prognosis.…”