Transactions of the Seventieth Annual Meeting of the American Association of Obstetricians and Gynecologists

Carcinoma of the vulva

Invasive vulvar cancer is a relatively rare tumor, accounting for 4% of all female genital malignant neoplasms. Although classically a disease of elderly women, the trend in recent years is an increasing prevalence among younger women, which cannot be accounted for by immune suppression alone. Human papillomavirus (HPV) is a key age-dependent risk factor that causes preinvasive disease in the form of vulvar intraepithelial neoplasia (VIN) that is often associated with a history of tobacco use. HPV-related VIN lesions are rarer in older women, and these malignancies may be associated with chronic vulvar dystrophies, such as lichen sclerosis, although a direct association remains unproven. Staging is determined surgically and impacts prognosis significantly, with early stages having favorable prognoses while advanced stages portend a much poorer prognosis. Early-stage cancers are managed surgically in most cases with radical excision and lymphadenectomy. Advances in techniques have favored decreasing radicality of surgery with closer margins and sentinel lymph node biopsy. Locally advanced tumors often require combined chemoradiation. Metastatic disease is treated with systemic therapies, traditionally with cytotoxic chemotherapy, though immunotherapy is gaining favorability as more encouraging data are resulting. Recurrences may be local or distant, and more than 80% will occur in the first 2 years after therapy, demanding initial close follow-up.

Surgical therapy for vulvar cancer involves wide defects that often require flap-based reconstruction. The goal of the reconstruction is fast wound healing with low donor site morbidity.

This is a retrospective observational cohort study in which we reviewed all patients who underwent surgery for vulvar cancer followed by reconstruction using the Superficial Circumflex Iliac Artery Perforator (SCIP) flap between 2015 and 2020. The primary outcome measure of this investigation was the incidence of wound complications. The secondary outcomes were the surgical indications in terms of establishing the anatomical subunits involved in the resection that made us choose this flap for reconstruction. This study adheres to the STROBE guidelines.

Thirty-two patients were included; in two cases, the flap was performed bilaterally for a total of 34 SCIP flaps. The mean age of patients was 70.6 ± 8.6 years, and the mean BMI was 26.8 ± 4.7. The SCIP flap was always feasible. The mean flap size was 128.8 ± 74.3cm². Three patients showed wound complications. In every patient, the defect involved the vulva, perineum and inguinal area; in 18 patients, the mons pubis was also involved. The mean follow-up was 30 months. During the follow-up, six patients died, and four showed local or nodal cancer relapse.

Our results suggest that the advantages of SCIP flap for the reconstruction of vulvoperineal defects secondary to vulvar cancer surgery include low complication rate, minimal donor site morbidity, quick dissection, proximity of donor and recipient sites, possibility to harvest large skin islands of variable thickness and chimeric flaps.

Le but de ce travail était d’évaluer l’impact clinique du ratio de la dissémination métastatique ganglionnaire inguinale (LNR) chez les patientes prises en charge pour un cancer vulvaire de type épidermoide.

La cohorte de l’étude était représentée par des patientes prises en charge pour un carcinome épidermoide vulvaire, entre janvier 2005 et décembre 2015, dans 5 institutions françaises avec bases de données prospectives.

Au toal, 636 femmes, parmi lesquelles 508 (79,9 %) ont eu une chirurgie ganglionnaire inguinale. Le seuil significatif du LNR a été déterminé par la méthode du minimal valeur de p.

Comparaison de la survie globale et sans récidive selon le LNR.

Au total, 176 femmes (34,6 %) avaient au moins un ganglion atteint. Il existait une différence significative de survie globale et de survie sans récidive selon que le LNR, soit > 0,2 ou non.

L’évaluation, dans notre étude, du ratio de ganglions positifs, semble démontrer que celui-ci pourrait être considéré comme un facteur pronostique à part entière.

The aim was to review the clinical impact of lymph node ratio (LNR) of groin metastatic nodal disease in women with vulvar squamous cell carcinoma.

Cohort study of women with vulvar squamous cell carcinoma, managed between January 2005 and December 2015, in five institutions in France with prospectively maintained databases (French multicenter tertiary care centers).

In total, 636 women managed for VSCC of whom 508 (79.9%) underwent surgical groin nodal staging.

Comparison of overall and recurrence free survival between women according to LNR.

In total, 176 women (34.6%) had at least one positive lymph node (LN). There was a significant differences for the 5-year overall survival and recurrence free survival rates between women with LNR > 0.2 and women with LNR < 0.2.

LNR seems to be a significant prognostic factor in women with vulvar squamous cell carcinoma.

This chapter covers cervical cancer, vulvar cancer, and vaginal cancer. It discusses the etiology, diagnosis, and pathologic features of all the different cancers in each category. Diagnosis and treatment of preinvasive in addition to invasive disease in all three categories are examined, including surgical therapy, radiation therapy, and chemotherapy. Recent studies and evidence in the diagnosis and treatment of these three very different cancers are reported.

Vulvar cancer is a rare condition that is being increasingly diagnosed in younger women. It is often diagnosed at a late stage due to delay in seeking medical advice. The staging and treatment of vulvar cancer is surgical and involves removal of the vulvar lesion along with a margin of normal skin. In most cases, an assessment of or removal of lymph nodes from one or both groins is also required. Vulvar cancer is curable in most. The management of vulvar cancer should be carried out in the setting of a multidisciplinary team that specializes in management of gynecological cancers.