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. The question has been raised
as to whether modified radical vulvar surgery (partial removal of the
entire vulva) has reduced the complications while preserving the
excellent disease-free survival and low recurrence rates seen with
the more radical approach.
A study in the October issue of Gynecologic Oncology, conducted by
Javier F. Magrina, MD, Mayo Clinic, Scottsdale, Arizona, and
colleagues, explored the appropriateness of the more conservative approach.
The researchers conducted a retrospective review of 225 patients with
vulvar cancer treated between January 1, 1976, and December 31, 1990.
Of the 225 patients, 134 patients had radical surgery; 91 patients
had modified radical surgery65 of whom had vulvar excision
alone and the remaining 26 of whom had lymph node removal via a
separate groin incision.
The results of both types of surgery in the 225 patients (mean age,
68.2 years) included the following:
Cancerous groin recurrences after lymphadenectomy were noted in 4 of
134 patients in the radical vulvar surgery group vs 2 of 26 patients
in the modified radical surgery group.
Subsequent cancerous groin node growth developed in 5 of the 78
patients, 65 of whom were treated with vulvar excision alone and 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 but in none of the
modified radical surgery group. Development of both groin and distant
metastasis occurred in only three patients treated by the modified
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 (10.8%) of 65 patients in
the vulvar excision group, 3 (11.5%) of 26 patients in the modified
radical surgery group, and 49 (36.6%) of 134 patients in the radical
The study concluded that modified radical vulvar surgery is
associated with decreased complications and improved 5-year overall
disease-free rates, as compared with 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, president of the Society of
Gynecologic Oncologists and director of the Department of Gynecologic
Oncology at the Mayo Clinic.
Coauthors of the study include Jeffrey Cornella, Department of
Obstetrics and Gynecology, Mayo Clinic, Scottsdale, Arizona; Amy
Weaver, Section of Biostatistics, Thomas A. Gaffey, MD, Division of
Anatomic Pathology, Maurice J. Webb, MD, and Karl C. Podratz, MD,
Section of Gynecologic Surgery, Mayo Clinic and Mayo Foundation,
Rochester, Minnesota; and Jesus Gonzalez-Bosquet, Hospital vall
DHebron, Barcelona, Spain.