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 .
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 .
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 .
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.