IMR Press / EJGO / Volume 23 / Issue 2 / pii/2002121

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.

Open Access Distinguished Expert Series

Have patients with early squamous carcinoma of the vulva been overtreated in the past? The Norwegian experience 1977-1991

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1 Departments of Gynecologic Oncology and Pathology, Norwegian Radium Hospital, Oslo (Norway)
Eur. J. Gynaecol. Oncol. 2002, 23(2), 93–103;
Published: 10 April 2002
Abstract

Objective. To evaluate different surgical approaches in early squamous vulvar cancer. Methods. Review of clinical and histopathologic data and follow-up information of 216 patients with clinical FIGO stage I-II disease, primarily treated by surgery from 1977-1991. Results. Eighty-nine patients underwent radical vulvectomy with bilateral groin dissection by en bloc excision, 60 by the triple incision technique, 20 individualized vulvar surgery with uni-or bilateral groin dissection, and 47 vulvar surgery only. Groin metastases occurred in 9% stage I and 25 % stage II disease. Groin involvement was not seen in stage I tumors with invasion depth ≤=l mm. Bilateral metastases occurred in medially located tumors of both stages, and laterally located stage II. Metastases were ipsilateral in lateral stage I. Separate groin dissection signifjcantly reduced morbidity. Sixty-six patients relapsed, 14 after more than 5 years. Vulvar recurrence was related to tumor dia­meter and the condition of the resection borders. The single most important predictor of death from vulvar cancer was the presence of inguinal femoral lymph node metastases. Conservative and individualized surgery did not compromise 5-year survival. Conclusions. A careful selection of patients fitted for less radical surgery is essential to avoid undertreatment. Groin dissection can be omitted in tumors with diameters ≤=2 cm and invasion depth ≤= 1 mm. At least ipsilateral groin dis­section is needed in all other cases. Groin dissection should be performed through separate incisions. Modified vul­vectomy is appropriate provided radicality can be obtained. Long-time follow-up is important as recurrences can be seen many years after primary therapy.

Keywords
Squamous carcinoma
vulva
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