经分别切口行双团队同期全外阴根治切除术和腹股沟-股部淋巴结切除术治疗局部晚期（FIGO 分期 IB≥4cm-III 期）鳞状外阴癌。

Two-team simultaneous total radical vulvectomy and inguino-femoral lymphadenectomy via separate incisions for locally advanced (FIGO stages IB ≥ 4 cm-III) squamous vulvar cancer.

机构信息

Department of Gynecology and Obstetrics, University of Florence, Florence, Italy

Department of Gynecology and Obstetrics, University of Florence, Florence, Italy.

出版信息

Anticancer Res. 2014 Dec;34(12):7345-50.

PMID:25503170

Abstract

AIM

To describe the feasibility, safety, and oncological outcomes of a modified triple-incision total radical vulvectomy and inguino-femoral lymphadenectomy in patients with locally advanced squamous vulvar cancer.

PATIENTS AND METHODS

A modified triple-incision technique performed by two surgical teams operating simultaneously under regional anesthesia was performed on a consecutive series of 57 patients with Fédération Internationale de Gynécologie Ostétrique (FIGO) stages IB ≥ 4 cm to III squamous vulvar cancer. Adjuvant radiation therapy was delivered according to margin status and groin involvement. Surgical outcomes and follow-up data were retrospectively analyzed.

RESULTS

The mean age of patients was 75.5 ± 10.7 years and 54 (94.7%) had at least one comorbidity. Fifteen (26.3%) had disease of clinical FIGO stage I ≥ 4 cm, 7 (12.3%) had stage II, and 35 (61.4%) had a stage III. All surgical procedures were completed as planned. The mean surgical duration was 108 ± 37 min. Major intraoperative complications were observed in two cases (3.5%). Twenty-one (36.8%) patients received adjuvant radiation therapy. During a mean follow-up of 51.6 ± 50.5 months, 29 (50.9%) patients developed local, regional or distant recurrence. The disease-free survival was 39.5 ± 20.9 months. Nineteen (33.3%) patients died of primary disease. Overall survival for the entire cohort was 65.4%, with 3-year and 5-year overall survival of 60.5% and 48.6%, respectively.

CONCLUSION

Our results seem to reveal that the procedure is safe, with surgical and oncological outcomes comparable to classic sequential triple-incision technique. The shortening of surgical duration along with the use of regional anesthesia can have significant advantages for perioperative care, reducing the global burden of treatment and increasing the number of patients eligible for therapeutic surgery.

摘要

目的

描述改良三切口全根治外阴切除术和腹股沟-股部淋巴结清扫术在局部晚期鳞状外阴癌患者中的可行性、安全性和肿瘤学结果。

患者和方法

连续 57 例国际妇产科联盟（FIGO）分期 IB≥4cm 至 III 期鳞状外阴癌患者接受改良三切口技术，由两个手术团队在区域麻醉下同时进行。根据切缘状态和腹股沟受累情况给予辅助放疗。回顾性分析手术结果和随访数据。

结果

患者的平均年龄为 75.5±10.7 岁，54 例（94.7%）至少有一种合并症。15 例（26.3%）有临床 FIGO 分期 I≥4cm 的疾病，7 例（12.3%）有 II 期疾病，35 例（61.4%）有 III 期疾病。所有手术均按计划完成。平均手术时间为 108±37min。术中主要并发症见于 2 例（3.5%）。21 例（36.8%）患者接受辅助放疗。在平均随访 51.6±50.5 个月期间，29 例（50.9%）患者出现局部、区域或远处复发。无病生存率为 39.5±20.9 个月。19 例（33.3%）患者死于原发性疾病。全队列总生存率为 65.4%，3 年和 5 年总生存率分别为 60.5%和 48.6%。