R. Fariaseisner et al., CONSERVATIVE AND INDIVIDUALIZED SURGERY FOR EARLY SQUAMOUS CARCINOMA OF THE VULVA - THE TREATMENT OF CHOICE FOR STAGE-I AND II (T1-2N0-1M0)DISEASE, Gynecologic oncology, 53(1), 1994, pp. 55-58
We studied the outcome of patients undergoing radical local excision (
modified radical vulvectomy) with inguinal-femoral lymphadenectomy thr
ough separate groin incisions for stage I and II invasive squamous car
cinoma of the vulva. The purpose was to determine whether less radical
and more individualized surgery is consistent with local control and
cure. We have reported previously our experience using radical local e
xcision and modified radical vulvectomy in stage I disease (Obstet. Gy
necol. 63, 155 (1984)) and with separate groin incisions (Obstet. Gyne
col. 58, 574 (1981)). This current report expands our experience with
stage I and adds stage II patients treated over the past decade. Seven
ty-four patients were studied retrospectively over the 5-year period e
nding in January 1990. Reviews of both patient charts and histopatholo
gy reports were correlated with recurrence and survival. Factors analy
zed included FIGO stage and grade, histology, lesion size and depth of
invasion, surgical procedure, radiotherapy, lymph node status, interv
al to and site of recurrence, and survival. Thirty-nine patients had s
tage I disease and 35 had stage II. The primary operation was a radica
l local excision (modified radical vulvectomy) in 56 patients and radi
cal vulvectomy in 18 patients; 13 underwent ipsilateral inguinal-femor
al lymphadenectomy and 58 bilateral lymphadenectomy, each through sepa
rate groin incisions. The survival of those treated conservatively (97
and 90% for stages I and II, respectively) is the same as those under
going a radical vulvectomy (100 and 75% for stages I and II, respectiv
ely) with only the presence of inguinal-femoral lymph node metastases
impacting negatively on survival. In the entire group, the survival fo
r negative and positive nodes was 98 and 45%, respectively. In conclus
ion, conservative, modified, and individualized vulvectomy in both sta
ge I and II disease is associated with the same outcome and survival a
s radical vulvectomy, and lymph node status is the most important prog
nostic factor. (C) 1994 Academic Press, Inc.