Carcinoma of the vulva

Way, Stanley

doi:10.1016/0002-9378(60)90626-8

Cited by 217 publications

(58 citation statements)

References 2 publications

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“…In patients without a groin recurrence, the mean number of removed lymph nodes was 16 (range 3-35). In patients who developed a groin recurrence after negative lymph nodes, the mean number of removed lymph nodes was 13 (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. This difference is not significant (t = 1,74: df = 90: P = 0.09).…”

Section: Recurrencesmentioning

confidence: 99%

“…In the early 1950s, Stanley Way introduced the radical vulvectomy with "en bloc" bilateral inguinofemoral lymphadenectomy as standard treatment for all operative vulvar cancers [3 4]. This strategy resulted in excellent survival rates up to 90% 5-year survival for patients without lymph node metastases (stages I and II) and an overall survival rate of about 70% [1,4]. However, the complication rate was high because of the extension of the operation.…”

Section: Introductionmentioning

confidence: 99%

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Patterns and frequency of recurrences of squamous cell carcinoma of the vulva

Woolderink

Bock

Hullu

et al. 2006

Gynecologic Oncology

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Objective. To analyze patterns and frequency of recurrences of squamous cell carcinoma (SCC) of the vulva after wide local excision (WLE) and superficial inguinal lymphadenectomy with separate incisions and to identify prognostic factors for the development of recurrences.Methods. Between January 1985 and December 1999, all 125 consecutive patients with primary SCC of the vulva, treated with WLE and superficial inguinal lymphadenectomy, were retrospectively analyzed. Recurrences were registered by localization as: local, skin bridge, groin or distant.Results. A local recurrence was diagnosed in 29 (23%) patients, 11 (9%) developed a groin and 4 (3%) a distant recurrence. No skin bridge recurrences were identified. The 5 years local relapse-free survival was 70%. After a first local recurrence, 72% of these patients developed a second local recurrence. Adjusted for other predictors, older age (>74 years) is an independent risk factor for local recurrences (HR: 2.38; 95%-C. I.: 1.08-5.23) and stage III/IV cancer for developing groin/distant recurrences (HR: 3.03; 95%-C.I.: 1.0-9.18).Conclusion. WLE and superficial inguinal lymphadenectomy with separate incisions result in a high groin recurrence rate in this study; superficial lymphadenectomy should be replaced by deep inguinofemoral lymphadenectomy. After a local recurrence, 72% of the patients developed a second local recurrence. These patients are at high risk and need a close follow-up.

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Section: Recurrencesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patterns and frequency of recurrences of squamous cell carcinoma of the vulva

Woolderink

Bock

Hullu

et al. 2006

Gynecologic Oncology

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“…Overall survival figures rose from 20% to over 60% after the introduction of radical vulvectomy with en bloc bilateral inguinofemoral and pelvic lymphadenectomy instead of simple local excision. 4,5 However, although overall survival figures were excellent, the short-term and long-term morbidity associated with this procedure were substantial. 3 Complications were related either to radical vulvectomy or to lymphadenectomy.…”

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confidence: 98%

Vulvar carcinoma

Hullu

Hollema²,

Lolkema³

et al. 2002

Cancer

251

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BACKGROUNDThe objective of this study was to determine whether modifications in the treatment of patients with vulvar carcinoma influence the rates of recurrence and survival.METHODSBetween 1982 and 1997, 253 patients with T1 and T2 invasive squamous cell carcinoma of the vulva were treated by essentially the same team of gynecologic oncologists, and 168 patients (Group I) underwent radical vulvectomy with en bloc inguinofemoral lymphadenectomy. Standard therapy was changed in 1993, and 85 patients (Group II) underwent wide local excision with inguinofemoral lymphadenectomy through separate incisions. The rates of recurrence and survival were compared between both groups.RESULTSIn Group II, the overall recurrence rate (33.3%) within 4 years was increased compared with Group I (19.9%; P = 0.03). In Group II, 5 of 79 patients (6.3%) developed fatal groin or skin bridge recurrences compared with 2 of 159 patients (1.3%) in Group I (P = 0.029); this did not result in a difference in overall survival. In Group II, 40 of 79 patients had tumor free margins measuring ≤ 8 mm, resulting in 9 local recurrences; whereas 39 of 79 patients had tumor free margins measuring > 8 mm, resulting in no local recurrences (P = 0.002).CONCLUSIONSThe current study showed that fatal recurrences in either the groin or the skin bridge were more frequent after wide local excision and inguinofemoral lymphadenectomy through separate incisions; however, probably due to lack of power, this did not result in shorter survival. In 40 of 79 patients, the histologic margins measured ≤ 8 mm, resulting in a high risk of local recurrences. Therefore, the authors recommend obtaining surgical margins of 2 cm for the local treatment of patients with vulvar carcinoma. Cancer 2002;95:2331–8. © 2002 American Cancer Society.DOI 10.1002/cncr.10969

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“…Between the skin and the inferior fascia of the urogenital diaphragm is the fatty tissue, which is divided into a superficial and a deep portion by the superficial fascia, or Colles' fascia [3]. In the deepest portion of the fatty tissue are the following structures, from the top downward: the body of the clitoris [4], the membranous urethra [5], the corpora cavernosa [6], the ischiocavernosi muscles [7], the bulbospongiosi muscles [8], Bartolin's glands [9], the transversus perinei superficialis muscle [10], and the perineal body [11].…”

Section: Landmarks Of Vulvar Topographic Anatomy Depthmentioning

confidence: 99%

“…uring the last 20 years, the standard en bloc radical vulvectomy and bilateral dissection of the inguinal and pelvic lymph nodes described by Taussig 1 of the U.S. and Way 2,3 of Great Britain has been modified by several authors according to a new conservative philosophy in oncologic practice. 4 -6 Therefore, it is now widely agreed that the modern approach to the management of vulvar carcinoma should be conservative and individualized.…”

mentioning

confidence: 99%