A review of complications associated with the surgical treatment of vulvar cancer

Wills, Angela and Obermair, Andreas (2013) A review of complications associated with the surgical treatment of vulvar cancer. Gynecologic Oncology, 131 2: 467-479. doi:10.1016/j.ygyno.2013.07.082


Author Wills, Angela
Obermair, Andreas
Title A review of complications associated with the surgical treatment of vulvar cancer
Journal name Gynecologic Oncology   Check publisher's open access policy
ISSN 0090-8258
1095-6859
Publication date 2013-01-01
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.ygyno.2013.07.082
Volume 131
Issue 2
Start page 467
End page 479
Total pages 13
Place of publication Maryland Heights, MO United States
Publisher Academic Press
Language eng
Subject 2729 Obstetrics and Gynaecology
2730 Oncology
Abstract Objective The mainstay of treatment for most vulvar malignancies is surgery to the vulva with lymphadenectomy to the inguino-femoral areas, plus radiotherapy or/and chemotherapy for locally advanced, or recurrent disease. Treatment is associated with significant physical, sexual, and psychological morbidity. The high morbidity rate has resulted in a continuing shift in treatment paradigms that focus on treatments that reduce morbidity without compromising cure rates. This paper reviews the complications associated with contemporary surgical treatment for vulva cancer and discusses preventative strategies. Methods A review of the English literature was undertaken for articles published between 1965 and August 31, 2012 to identify articles that assessed complications resulting from surgery to the vulva or groins in patients with vulva cancer. Two independent researchers selected and qualitatively analyzed the articles using a predetermined protocol. Results The heterogeneity of articles and differences in definitions and outcomes made this unsuitable for meta-analysis. Most studies advocated for change in surgical technique to reduce complications associated with inguino-femoral lymphadenectomy and surgery to the vulva, with varying success. The most effective means of preventing complications is by omitting systematic lymph node dissection. This can be achieved safely through sentinel lymph node biopsy. Saphenous vein sparing, VTE prophylaxis, the use of flaps and grafts, and preoperative counseling are additional ways to decrease morbidity. Conclusion Despite technical advances, complications following surgical treatment for vulva cancer remain high. More research, particularly multi centered randomized controlled trials to improve the quality of evidence and studies that focus on complications as an outcome measure and analyze individual surgeon complication rates, are needed. Measures also need to be standardized throughout the gynecologic oncology community to allow for better comparison between studies.
Keyword Complications
Inguino-femoral lymphadenectomy
Morbidity
Prevention
Vulvar cancer
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Medicine Publications
 
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