Hacker Neville F, Barlow Ellen L
School of Women's and Children's Health, Faculty of Medicine & Health, University of New South Wales, Sydney 2052, Australia.
Gynaecological Cancer Research Group, School of Women' and Children's Health, Faculty of Medicine & Health, University of New South Wales, Sydney 2052, Australia.
Cancers (Basel). 2024 Aug 28;16(17):2991. doi: 10.3390/cancers16172991.
Vulvar cancer is a rare disease, and cure rates were low until the mid-20th century. The introduction of an en bloc radical vulvectomy and bilateral groin and pelvic lymph node dissection saw them rise from 15-20% to 60-70%. However, this very radical surgery was associated with high physical and psychological morbidity. Wounds were usually left open to granulate, and the average post-operative hospital stay was about 90 days. Many attempts have been made to decrease morbidity without compromising survival. Modifications that have proven to be successful are as follows: (i) the elimination of routine pelvic node dissection, (ii) the use of separate incisions for groin dissection, (iii) the use of unilateral groin dissection for lateral, unifocal lesions, (iv) and radical local excision with 1 cm surgical margins for unifocal lesions. Sentinel node biopsy with ultrasonic groin surveillance for patients with node-negative disease has been the most recent modification and is advocated for patients whose primary cancer is <4 cm in diameter. Controversy currently exists around the need for 1 cm surgical margins around all primary lesions and on the appropriate ultrasonic surveillance for patients with negative sentinel nodes.
外阴癌是一种罕见疾病，直到20世纪中叶其治愈率一直很低。整块根治性外阴切除术以及双侧腹股沟和盆腔淋巴结清扫术的引入使治愈率从15% - 20%提高到了60% - 70%。然而，这种非常激进的手术伴随着较高的生理和心理发病率。伤口通常敞开让其形成肉芽组织，术后平均住院时间约为90天。人们已经进行了许多尝试以在不影响生存率的情况下降低发病率。已被证明成功的改良方法如下：（i）取消常规盆腔淋巴结清扫；（ii）腹股沟清扫采用单独切口；（iii）对于外侧单灶性病变采用单侧腹股沟清扫；（iv）对于单灶性病变采用手术切缘为1厘米的根治性局部切除术。对于淋巴结阴性的患者，前哨淋巴结活检联合超声腹股沟监测是最近的改良方法，对于原发性癌直径<4厘米的患者提倡采用。目前对于所有原发性病变周围是否需要1厘米手术切缘以及前哨淋巴结阴性患者的适当超声监测存在争议。
