CONSERVATIVE TRENDS IN THE SURGICAL-MANAGEMENT OF VULVAR CANCER - A UNIVERSITY-OF-MIAMI PATIENT-CARE EVALUATION STUDY

The objective of this study was to determine the impact of conservativ e surgical trends in vulvar cancer related to morbidity, adequacy of s urgical resection, recurrence rates and survival. A retrospective anal yses of 160 patients treated surgically for vulvar cancer at the Unive rsity of Miami/Jackson Memorial Medical Center from January 1, 1973 to December 31, 1991 was performed. Patients were divided into two group s based on the date of surgery. Group 1 patients (82) had surgery betw een January 1, 1973 to December 31, 1982. Group 2 patients (78) had su rgery between January 1, 1983 and December 31, 1991. Patient demograph ics, stage, T N M classification and grade were not statistically diff erent between groups. There was a significant trend away from curvilin ear en bloc resection toward the use of a separate triple incision (P = 0.0001). Decreases in exenterative surgery and radical vulvectomy an d concurrent increases in radical local excision and hemivulvectomy oc curred (P = 0.014). In addition, deep pelvic node dissection was aband oned and an increase in unilateral vs bilateral inguinal node dissecti on also occurred, yet this did not reach significance (P = 0.09). No d ifference in the mean number of total nodes, number of groin nodes obt ained and percentage of patients with positive nodes or positive margi ns was found. With the trend toward more conservative surgery, statist ically significant decreases in mean estimated blood loss (1334 ml to 834 ml; P = 0.009), length of days hospitalized (31.5 to 19.7; P = 0.0 01) and operative times (5.3 h to 4.1 h; P = 0.002) occurred. No diffe rence was noted in minor wound breakdown rates; however, there were si gnificantly fewer major wound breakdowns in the conservatively treated group (43.2% vs 16.6%) (P = 0.0003). Major wound breakdowns occurred more frequently in the abdomen/groin region in group 1 vs 2 (24.7% vs 7.7%; P = 0.004). Frequencies of wound breakdown in relation to the nu mber of clinical risk factors (smoking, hypertension, diabetes, obesit y, other) for all patients was found to be highly statistically signif icant (P = 0.006). When evaluating patients with squamous carcinoma on ly, recurrence rates and 5-year survivals were not statistically diffe rent (P = 0.45). The trend toward conservative surgical management of vulvar carcinoma significantly reduced morbidity with no impact on rec urrence rates or 5-year survival.