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

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.

Management of Vulvovaginal Cellular Angiofibroma: A Single-Center Experience

“…Therefore, in our study, primary closure of wound was accompanied without reconstructive surgery. Consistent with our opinion, after tumor excision, primary closure rather than reconstructive surgery was performed in a previous retrospective study ( 12 ). However, we are in favor of the idealism of reconstructive surgery, to obtain tension free skin closure with good quality tissues, to fill dead space, to restore normal anatomy, and to maintain function ( 16 ).…”

“…Additionally, regarding wether reconstructive surgery should be performed. Generally, for vulvar caner, surgeons always aim for surgical margins of 2 cm to achieve pathological margins of at least 8 mm to minimize local disease recurrence, removing a large amount of tissue ( 11 ).In these circumstances, reconstructive surgery is often necessary, after radical wide local excision of tumor or radical vulvectomy, to reduce the risk of postoperative complication ( 12 – 15 ). Female cellular angiofibroma predominantly occurs in the superficial soft tissues of the vulva ( 2 ).…”

Perforator versus Non-Perforator Flap-Based Vulvoperineal Reconstruction—A Systematic Review and Meta-Analysis

“…Forty-nine studies fulfilled the selection criteria. Among them, thirty-two studies analyzed non-perforator flaps [ 9 , 10 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ], only nine studies focused on perforator flaps [ 21 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], and eight studies focused on both [ 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ] ( Figure 2 ).…”

“…The 49 studies were conducted in Europe ( n = 29) [ 9 , 10 , 20 , 22 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 47 , 50 , 52 , 54 , 57 , 58 , 62 , 65 ], the United States ( n = 5) [ 29 , 44 , 46 , 48 , 49 ], and Asia ( n = 15) [ 21 , 23 , 32 , 33 , 37 , 51 , 53 , 55 , 56 , 59 , 60 , 61 , 63 , 64 , 66 ] and were published between 1990 and 2022. Two studies were multicentric [ 28 , 50 ]; the others were monocentric.…”

“…Muallem 2022 [24] 126 Flap combination (22), local fasciocutaneous flap (84), myocutaneous flap (20) Shin 2022 [51] Local perforator fasciocutaneous flap (27) Zhang 2022 [61] Local fasciocutaneous flap (30), VRAM (2) ALT (2) Aksan 2021 [25] Local fasciocutaneous flap (29), skin graft (1), VRAM (1) Giannini 2021 [26] Local fasciocutaneous flap (40) Tock 2019 [27] Gluteal thigh flap ( 16), local fasciocutaneous flap (45) Fin 2018 [28] Local fasciocutaneous flap (59) Hand 2018 [29] Local fasciocutaneous flap (42) Hellinga 2018 [9] Local fasciocutaneous flap (89) Confalonieri 2017 [10] 365 Local fasciocutaneous flap (365) Gentileschi 2017 [52] ALT (16) Lange 2017 [20] 114 Local fasciocutaneous flap (114) Chang 2016 [21] PAP ( 19) Conri 2016 [30] Local fasciocutaneous flap (36) Herraiz Roda 2016 [31] Local fasciocutaneous flap (17) Huang 2015 [53] Local perforator fasciocutaneous flap (16), PAP (11) Kim 2015 [32] Local fasciocutaneous flap (41) Negosanti 2015 [62] Local fasciocutaneous flap ( 28) DIEP (5) Nomura 2015 [33] Local fasciocutaneous flap ( 16), non-specified flap (3) Zhang 2015 [63] Gracilis myocutaneous flap (1), TRAM (1) ALT (24), DIEP (1) Zhang 2015_2 [64] Gracilis myocutaneous flap (2), TRAM (1) ALT ( 24), DIEP (6), pudendal thigh fasciocutaneous flap (7) Benedetti Panici 2014 [34] Local fasciocutaneous flap (29)…”