Adjuvant treatment with radiation after radical
vulvectomy and BGND has proven to significantly reduce local relapse and decreased cancer-related deaths from GOG 37 study in patients with positive groin nodes [22].
Type of surgery Type of surgery, n FIGO stage Patients, N Patients with Nodal Excision primary excision of vulvar surgery, N only tumour 1 71 63 19 2 13 8 1 3 55 38 3 4 41 4 Total 180 113 4 19 Type of surgery, n Patients with recurrence of disease after surgery, FIGO stage Tumour + Ano- n (%) nodal
vulvectomy + excision nodes 1 44 14 (22.2) 2 4 3 0 (0) 3 28 7 15 (39.5) 4 3 1 2 (50.0) Total 79 11 31/105 * (29.5) FIGO = International Federation of Gynecology and Obstetrics.
Of these, one patient who had initially presented with multiple verrucous lesions and underwent simple
vulvectomy subsequently developed nodal recurrence at 5 months and was treated with right ilioinguinal block dissection (IIBD) followed by adjuvant RT.
Although studies have not found correlation between extent of surgery (local excision, simple
vulvectomy, radical
vulvectomy, partial vaginectomy, radical vaginectomy, exenteration) and overall survival rate [17, 18], it is agreed that the resection specimen should have at least 1 cm clear margins [19].
Colleen: A
vulvectomy. Robichaud: What did he remove?
Quality of life and psychological state after radical
vulvectomy. Journal of Psychosomatic Obstetrics and Gynecology, 5, 263-269.
About half the women had five or more surgeries, including cone biopsy, laser ablation, and
vulvectomy. Seven women were diagnosed with HPV genital cancer before the age of 41; one has died.
Last FU 1 2 months 2 Lost to FU 3 1 month 4 1 (Thoracic 1 month and lumbar vertebrae) Table 8: Local Recurrence Histopathology stage after APR Region Involved [T.sub.3][N.sub.2] B/L inguinal [M.sub.0] obturator, common (Dukes' C) iliac lymph nodes + severe Hydronephrosis (treated by PCN) Anaplastic Recurrent lesion malignancy adherent to posterior urinary bladder wall [T.sub.3][N.sub.2] Perineal region [M.sub.0] [T.sub.2][N.sub.0] Perineal region + [M.sub.0] Vaginal involvement Basaloid carcinoma Vulva (
Vulvectomy performed) [T.sub.3][N.sub.2] Paraaortic and R.
The clinical vignette that was used by the CPT Editorial Panel in valuing code 56620 (
Vulvectomy simple; partial) reads (1):
As late as the mid-1960s, full or deep
vulvectomy was the standard treatment [65].
With invasion or secondary disease, the recurrence rate is 65%, he added, noting that even after a radical
vulvectomy, the recurrence rate is about 20%.
Treatment: Wide excision of the lesion (
VULVECTOMY) was done.
