Treatment and Survival Outcomes of Surgery for Carcinoma Vulva
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ORIGINAL ARTICLE
Treatment and Survival Outcomes of Surgery for Carcinoma Vulva Sandipan Chowdhuri1 • Anitha Thomas1 • Vinotha Thomas1 • Ajit Sebastian1 • Thomas Samuel Ram2 Thenmozhi Mani3 • Rachel George Chandy1 • Abraham Peedicayil1
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Received: 12 July 2020 / Revised: 30 July 2020 / Accepted: 6 August 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Purpose To study treatment and survival outcomes of carcinoma vulva. Methods The electronic charts of 30 patients with carcinoma vulva operated between October 2010 and December 2015 were reviewed. Univariate cox-proportional hazard tests were done for potential risk factors. Survival analysis was done using Kaplan–Meier plots and the log rank test. Result The median age was 59 with a range of 27–82 years. Most common (90%) histological type was squamous cell carcinoma. Most (66.7%) patients had early stage disease, while stage III was seen in 23.3% and stage IV in 10%. Primary surgery was done in 27/30 (90%) patients while three with stage IV had surgery following neoadjuvant therapy. Complications included wound dehiscence in 6/30 (20%), lymphocysts in 11/30 (36.7%), urinary infections in 3/30 (10%) and one death within 30 days. There were 6 recurrences (20%) and 10 deaths (33.3%). Mean recurrence-free survival was 84.6 (95% CI 67.6–101.6) months. Mean overall survival time was 70 (95% CI 53.1–86.9) months. Conclusions Radical wide local excision with groin node dissection is possible in most early cases. Flaps can reduce wound breakdown. A multidisciplinary approach can ensure long-term survival with good quality of life. Keywords Cancer vulva Treatment Complications Recurrence Survival
Introduction In India, 50–60% of all cancers among women are related mainly to the four organs: cervix uteri, breast, corpus uterus and ovaries [1]. Vulvar cancer is one of the rare cancers of female reproductive tract representing 2–5% of gynecologic malignancies and 0.6% of all cancers in women [2]. The age of presentation is usually between 60 and 80 years. The most common symptom is pruritus, and patients have a swelling or ulcer of the vulva. The treatment is usually surgical and involves wide local excision with adequate margins and groin node dissection
& Abraham Peedicayil [email protected] 1
2
3
Department of Gynaecologic Oncology, Christian Medical College and Hospital, Vellore 632004, India Department of Radiation Oncology, Christian Medical College and Hospital, Vellore 632004, India Department of Biostatistics, Christian Medical College and Hospital, Vellore 632004, India
[3]. Initially, radical vulvectomy surgery consisted of en bloc excision of vulva with inguinal nodes by a butterflyshaped incision. The psychosexual sequelae and morbidity associated with such extensive dissection have led to a more conservative surgical approach. Nowadays, radical wide local excision of the vulval lesion with 1–2 cm margins is done using separate incisions for inguinal node dissections. Being one of the less common types of genital cancer
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