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 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 (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 surgery group.
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.