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. 2000;2000(2):CD002036.
doi: 10.1002/14651858.CD002036.

Surgical interventions for early squamous cell carcinoma of the vulva

A Ansink  1 , J van der Velden
Affiliations

Surgical interventions for early squamous cell carcinoma of the vulva

A Ansink et al. Cochrane Database Syst Rev. 2000.

Abstract

Background: Radical surgery has been standard treatment for patients with early vulvar cancer since mid century. Survival figures are excellent, but complication rates are high. Over the last two decades, surgical treatment has become more individualised in order to decrease complications in patients with limited disease.

Objectives: To determine whether the effectiveness and safety of individualised treatment is comparable with that of more extensive (non-individualised) surgery.

Search strategy: The cirteria set by the Cochrane Gynaecological Cancer Group were used. We searched Medline and Embase (last search on 16 November 1999) We used our own publication archives, based on a prospective handsearch of six leading relevant journalswhich was started in December 1986. Reference lists of identified studies, gynaecological cancer handbooks and conference abstracts were also used.

Selection criteria: Types of study: RCT's, case control and observational studies on the effectiveness of surgical treatment of vulvar cancer.

Types of participants: patients with cT1N0M0 squamous cell carcinoma of the vulva. Types of interventions: local surgical treatment as well as regional lymph node dissection. Types of outcome measurements: overall, disease specific and disease free survival; treatment complications; quality of life issues.

Data collection and analysis: The two reviewers independently assessed study quality and extracted data.

Main results: Only two studies with a total of 94 participants were included in the review. Both were observational studies. None of the other eleven considered studies met the minimum criteria as set by the Cochrane Collaboration. From these two studies, it can be concluded that: 1. radical local excision is as safe as a radical vulvectomy; 2. An ipsilateral lymph node dissection is safe in patients with a well lateralised tumour, and 3. A superficial groin node dissection is not as safe as a full femoro-inguinal groin node dissection. The fourth question we intended to answer is of great clinical importance: is the triple incision technique as safe as an en bloc dissection? This question could only be answered by using some of the unselected studies. From these studies, the triple incision technique appears to be as safe as the en bloc technique.

Reviewer's conclusions: The available evidence regarding surgical treatment of early vulvar cancer is generally of poor quality. From the evidence with sufficient quality we conclude that radical local excision, ipsilateral lymph node dissection in lateral tumors and triple incision technique are safe treatment options for early vulvar cancer. However, superficial groin node dissection results in an excess of groin recurrences compared to a full femoro-inguinal groin node dissection.

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Conflict of interest statement

None known

References

References to studies included in this review

Burke 1995 {published data only}
    1. Burke TW, Levenback C, Coleman RL, Morris M, Silva EG, Gershenson DM. Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy.. Gynecologic Oncology 1995;57:215‐20. - PubMed
de Hullu 2002 {published data only}
    1. Hullu JA, Hollema H, Lolkema S, Boezen M, Boonstra H, Burger MP, et al. Vulvar Carcinoma, The Price of Less Radical Surgery. Cancer 2002;95:233‐8. - PubMed
DiSaia 1979 {published data only}
    1. DiSaia PJ, Creasman WT, Rich WM. An alternate approach to early cancer of the vulva. American Journal of Obstetrics and Gynecology 1979;133:825‐30. - PubMed

References to studies excluded from this review

Andrews 1994 {published data only}
    1. Andrews SJ, Williams BT, DePriest PD, Gallion HH, Hunter JE, Buckley SL, et al. Therapautic implications of lymph nodal spread in lateral T1 and T2 squamous cell carcinoma of the vulva. Gynecologic Oncology 1994;55:41‐6. - PubMed
Arvas 2005 {published data only}
    1. Arvas M, Köse F, Gezer A, Demirkiran F, Tulunay G, Kösebay D. Radical versus conservative surgery for vulvar carcinoma. International Journal of Gynecology and Obstetrics 2005;88:127‐133. - PubMed
Ayhan 1988 {published data only}
    1. Ayhan Ali, Yuce K, Pekin S, Ayhan Ayase, Ozen E. Radical vulvectomy for squamous cell carcinoma of the vulva. International Journal of Gynecology and Obstetrics 1988;26:105‐8. - PubMed
Burger 1996 {published data only}
    1. Burger MPM, Hollema H, Bouma J. The site of groin node metastases in unilateral vulvar carcinoma. International Journal of Gynecology and Obstetrics 1996;6:318‐22.
Farias‐Eisner 1994 {published data only}
    1. Farias‐Eisner R, Crisano FD, Grouse D, Leuchter RS, Karlan BY, Lagasse LD, 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 1994;53:55‐8. - PubMed
Grimshaw 1993 {published data only}
    1. Grimshaw RN, Murdoch JB, Monaghan JM. Radical vulvectomy and bilateral inguinal‐femoral lymphadenectomy through separate incisions ‐ experience with 100 cases. International Journal of Gynecology and Obstetrics 1993;3:18‐23. - PubMed
Hacker 1981 {published data only}
    1. Hacker NF, Leuchter RS, Berek JS, Castaldo TW, Lagasse LD. Radical vulvectomy and bilateral inguinal lymphadenectomy through separate groin incisions. Obstetrics and Gynecology 1981;8:574‐9. - PubMed
Heaps 1990 {published data only}
    1. Heaps JM, Fu YS, Montz FJ, Hacker NF, Berek JS. Surgical‐pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecologic Oncology 1990;38:309‐14. - PubMed
Helm 1992 {published data only}
    1. Helm CW, Hatch K, Austin JM, Partridge EE, Soong SJ, Elder JE, et al. A matched comparison of single and triple incision techniques for the surgical treatment of carcinoma of the vulva. Gynecologic Oncology 1992;46:150‐6. - PubMed
Hoffman 1992 {published data only}
    1. Hoffman MS, Roberts WS, Finan MA, Fiorica JV, Bryson SCP, Ruffolo EH, et al. A comparative study of radical vulvectomy and modified radical vulvectomy for the treatment of invasive squamous cell carcinoma of the vulva. Gynecologic Oncology 1992;45:192‐7. - PubMed
Siller 1995 {published data only}
    1. Siller BS, Alvarez RD, Conner WD, McCullough CH, Kilgore LC, Partridge EE, et al. T2/3 vulvar cancer: a case control study of triple incision versus en bloc radical vulvectomy and inguinal lymphadenectomy. Gynecologic Oncology 1995;57:335‐9. - PubMed
Stehman 1992a {published data only}
    1. Stehman FB, Bundy BN, Dvoretsky PM, Creasman WT. Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstetrics and Gynecology 1992;79:490‐7. - PubMed

Additional references

Berek 1994
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Hacker 1994
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Levenback 1996
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