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Vulvar cancer surgery

Baiocchi, Glaucoa; Rocha, Rafael M.b

Current Opinion in Obstetrics & Gynecology: February 2014 - Volume 26 - Issue 1 - p 9–17
doi: 10.1097/GCO.0000000000000033
GYNECOLOGIC CANCER: Edited by Anne O. Rodriguez

Purpose of review: Surgical treatment of vulvar cancer has been shifted from ultraradical procedures associated with huge morbidity to less extensive surgery with better psychosexual result and less morbidity, without compromising survival. The authors review and discuss the recent literature regarding the surgical management of vulvar squamous cell carcinoma.

Recent findings: Surgery remains the cornerstone in the treatment of vulvar cancer. Radical vulvectomy with inguinofemoral lymphadenectomy has been replaced by radical local excision with sentinel node procedure for early disease. However, the role and distance of pathological margins are still on debate. Recent results from a large prospective trial corroborate the safety of sentinel node biopsy for early disease, even after primary tumor resection. An experienced team should perform sentinel node procedure using combined technique (blue dye and lymphoscintigraphy) and ultrastaging pathology. Moreover, midline tumors still need lymph node biopsy from both groins.

Summary: Primary vulvar cancer may be safely treated with radical/wide local resection. In case of other suspicious lesion or multifocal disease, radical vulvectomy is performed. Patients with unifocal disease, tumor size less than 4 cm, and clinically negative groins are candidates to sentinel node procedure. In the case of clinically positive node or sentinel node metastasis, a systematic inguinofemoral lymphadenectomy should be performed.

aDepartment of Gynecologic Oncology

bDepartment of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil

Correspondence to Glauco Baiocchi, MD, PhD, Departamento de Ginecologia Oncológica, AC Camargo Cancer Center, Rua Antonio Prudente, 211, 01509-010, São Paulo, Brazil. Tel: +55 11 2189 5110; fax: +55 11 2114 6072; e-mail: glbaiocchi@yahoo.com.br

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins