Radical vulvectomy. The decision for the incision.

BACKGROUND

An analysis of survival and complications related to the type of radical vulvectomy operation performed is reported.

METHODS

Clinical records and pathology reports were reviewed for the time period 1975-1989. The operation, complications, and site of recurrent disease were recorded.

RESULTS

The following types of surgical vulvectomies were used: radical vulvectomy (28 cases), the technique with three separate incisions (42 cases), and en bloc radical vulvectomy (94 cases). There was no significant difference in survival between the patients receiving en bloc radical vulvectomy or three separate incisions when analyzed by stage of disease. The following numbers of local/regional recurrences occurred among patients receiving the following treatment regimens: radical vulvectomy, seven; the technique with three separate incisions, six; and en bloc radical vulvectomy, five. Three patients treated by the separate-incision technique had a bridge recurrence. Complications were more frequent in those receiving the en bloc technique compared with those receiving the technique with three separate incisions: wound breakdown, 64% versus 38%, respectively (P = 0.005); wound infection, 20% versus 12%, respectively (P = 0.4); wound cellulitis, 21% versus 14%, respectively (P = 0.4); and lymphocyst formation, 28% versus 14%, respectively (P = 0.08). Drain placement or prophylactic antibiotics did not reduce wound infection or wound breakdown significantly. The most common sites of metastatic disease were the lungs and subcutaneous tissues of the leg. Hypercalcemia occurred in four patients, with the sites of metastatic disease being the subcutaneous tissue of the thigh (three patients) and pubic bone (one patient).

CONCLUSIONS

The technique with three separate incisions provides satisfactory survival results with less morbidity compared with the en bloc technique of radical vulvectomy.