Muallem Mustafa Zelal, Sehouli Jalid, Miranda Andrea, Plett Helmut, Sayasneh Ahmad, Diab Yasser, Muallem Jumana, Hatoum Imad
Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany.
Department of Gynecological Oncology, Surgical Oncology Directorate, Guy's and St Thomas' NHS Foundation Trust, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, Westminster Bridge Road, London SE1 7EH, UK.
Cancers (Basel). 2022 Mar 26;14(7):1695. doi: 10.3390/cancers14071695.
(1) Background: plastic reconstruction in vulvar surgery can lead to a better treatment outcome than primary closure. This study aims to compare the preoperative parameters (co-morbidities and tumor size) and postoperative results (tumor free margins and wound healing) between the primary closure and reconstructive surgery after vulvar cancer surgery; (2) Methods: this is a retrospective analysis of prospectively collected data from 2009 to 2021 at a tertiary cancer institution; (3) Results: 177 patients were included in the final analysis (51 patients had primary closure PC and 126 had reconstructive surgery RS). About half (49%) of the PC patients had no co-morbidities ( = 0.043). The RS group had a 45 mm median maximal tumor diameter compared to the PC group's 23 mm ( = 0.013). More than 90% of RS and 80% of PC had tumor-free margins ( = 0.1). Both groups had anterior vulvar excision as the most common surgery (52.4% RS vs. 23.5% PC; = 0.001). Both groups had identical rates of wound healing disorders. In a median follow-up of 39 months; recurrent disease was found in 23.5% of PC vs. 10.3% in RS ( = 0.012). In terms of overall survival there was no significant difference between the both groups; (4) Conclusions: reconstructive vulvar surgery enables enhanced complete resection rates of larger vulvar tumors with better anatomical restoration and a comparable wound recovery in comparison to primary closure. This results in a lower recurrence rate despite the increased tumor volume.
(1) 背景：外阴手术中的整形重建比一期缝合能带来更好的治疗效果。本研究旨在比较外阴癌手术后一期缝合与重建手术的术前参数（合并症和肿瘤大小）及术后结果（切缘无肿瘤和伤口愈合情况）；(2) 方法：这是一项对2009年至2021年在一家三级癌症机构前瞻性收集的数据进行的回顾性分析；(3) 结果：177例患者纳入最终分析（51例行一期缝合[PC]，126例行重建手术[RS]）。约一半（49%）的PC患者无合并症（P = 0.043）。RS组的最大肿瘤直径中位数为45 mm，而PC组为23 mm（P = 0.013）。超过90%的RS患者和80%的PC患者切缘无肿瘤（P = 0.1）。两组最常见的手术均为外阴前部切除术（RS组为52.4%，PC组为23.5%；P = 0.001）。两组伤口愈合障碍发生率相同。中位随访39个月；PC组复发性疾病发生率为23.5%，RS组为10.3%（P = 0.012）。在总生存率方面，两组之间无显著差异；(4) 结论：与一期缝合相比，外阴重建手术能提高较大外阴肿瘤的完整切除率，实现更好的解剖修复且伤口恢复情况相当。尽管肿瘤体积增大，但复发率更低。
