Recon­struc­tive Surgery ver­sus Pri­ma­ry Clo­sure fol­low­ing Vul­var Can­cer Exci­sion: A Wide Sin­gle-Cen­ter Experience

Authors

Mustafa Zelal Muallem ¹, Jalid Sehouli ¹, Andrea Miran­da ¹, Hel­mut Plett ¹, Ahmad Sayas­neh ², Yass­er Diab ³, Jumana Muallem ¹, Imad Hatoum ¹

Sim­ple Summary

When it comes to advanced vul­val can­cer man­age­ment, there is a crit­i­cal quandary to con­sid­er. This is owing to the severe neg­a­tive impact of demoli­tive surgery on women who are afflict­ed by both func­tion­al and psy­cho­log­i­cal con­se­quences of the pro­ce­dure. Pri­ma­ry clo­sure of vul­var and/or per­ineal defects can be accom­plished with­out dif­fi­cul­ty in many sit­u­a­tions, but this is accom­pa­nied by ten­sion of the skin clo­sure and dis­tor­tion of the anato­my. In these cir­cum­stances, recon­struc­tive surgery will be required to restore the anatom­i­cal and func­tion­al char­ac­ter­is­tics of the vul­va. In this paper, we share our sub­stan­tial exper­tise of pri­ma­ry clo­sure ver­sus recon­struc­tion after demoli­tive surgery of advanced vul­var can­cer, and we dis­cuss our find­ings in light of the literature.

Abstract

(1) Back­ground: plas­tic recon­struc­tion in vul­var surgery can lead to a bet­ter treat­ment out­come than pri­ma­ry clo­sure. This study aims to com­pare the pre­op­er­a­tive para­me­ters (co-mor­bidi­ties and tumor size) and post­op­er­a­tive results (tumor free mar­gins and wound heal­ing) between the pri­ma­ry clo­sure and recon­struc­tive surgery after vul­var can­cer surgery; (2) Meth­ods: this is a ret­ro­spec­tive analy­sis of prospec­tive­ly col­lect­ed data from 2009 to 2021 at a ter­tiary can­cer insti­tu­tion; (3) Results: 177 patients were includ­ed in the final analy­sis (51 patients had pri­ma­ry clo­sure PC and 126 had recon­struc­tive surgery RS). About half (49%) of the PC patients had no co-mor­bidi­ties (p = 0.043). The RS group had a 45 mm medi­an max­i­mal tumor diam­e­ter com­pared to the PC group’s 23 mm (p = 0.013). More than 90% of RS and 80% of PC had tumor-free mar­gins (p = 0.1). Both groups had ante­ri­or vul­var exci­sion as the most com­mon surgery (52.4% RS vs. 23.5% PC; p = 0.001). Both groups had iden­ti­cal rates of wound heal­ing dis­or­ders. In a medi­an fol­low-up of 39 months; recur­rent dis­ease was found in 23.5% of PC vs. 10.3% in RS (p = 0.012). In terms of over­all sur­vival there was no sig­nif­i­cant dif­fer­ence between the both groups; (4) Con­clu­sions: recon­struc­tive vul­var surgery enables enhanced com­plete resec­tion rates of larg­er vul­var tumors with bet­ter anatom­i­cal restora­tion and a com­pa­ra­ble wound recov­ery in com­par­i­son to pri­ma­ry clo­sure. This results in a low­er recur­rence rate despite the increased tumor volume.

Ref­er­ences

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