scholarly journals Personalized reconstructive and plastic approach in the surgical treatment of vulvar cancer

2021 ◽  
Vol 20 (2) ◽  
pp. 12-16
Author(s):  
A. A. Mukhin ◽  
A. V. Taratonov
Keyword(s):  
Surgical Treatment ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Defect Closure ◽  
Anatomical Structures ◽  
Clinical Center ◽  
Vulvar Reconstruction ◽  
Medial Surfaces ◽  
Treatment Volume

Introduction. The choice of a rational method of treatment in vulvar cancer is one of the most actual and difficult problems of modern clinical oncology. In the majority of cases vulvar cancer occurs in elderly and senile patients, as well as in some patients with locally advanced form. The aim of the investigation was to assess the possibility of reconstruction after surgical treatment of vulvar cancer.Materials and Methods. A study was conducted involving 151 patients with squamous cell vulvar cancer in whom the gynecological oncology department of Chelyabinsk regional clinical center of oncology and nuclear medicine performed surgical treatment by various methods in the following volume: dilated vulvectomy with the resection of adjacent anatomical structures with reconstructive and plastic component.Results. The original ways of plasty of the postoperative wound after vulvectomy were evaluated, the minimum risk of  complications was revealed. The presented technologies permit to use additional variants of the wound defect reconstruction and have a number of advantages in comparison with two dermalfascial flaps from the medial surfaces of the femur used earlier. Discussion. Studies have shown that vulvar reconstruction using skin flaps can avoid complications and improve patients' quality of life. Reconstruction with flaps is not currently an accepted standard of treatment for vulvar cancer. Conclusion. The methods of the wound defect closure are possible after radical vulvectomy in patients with squamous cell vulvar cancer and resection of adjacent anatomical structures without reduction of surgical treatment volume. These methods of wound defect closure contribute to the reduction of postoperative complications and significantly reduce postoperative stay in a medical institution.

Does time to completion of radiation treatment in locally advanced vulvar cancer impact survival?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5593-5593
Author(s):  
Nancy T. Nguyen ◽  
Xiao Zhao ◽  
Matthew Ponzini ◽  
Machelle Wilson ◽  
Gary S. Leiserowitz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Radiation Treatment ◽  
Locally Advanced ◽  
Group Versus ◽  
Figo Stage ◽  
Concurrent Chemotherapy ◽  
Stage Ii ◽  
Event Analysis

5593 Background: Although well established in cervical cancer, it is unclear whether time from initiation to completion of radiation therapy for vulvar cancer affects survival outcomes. We seek to assess if completion of radiation, either alone (RT) or as concurrent chemoradiation (CRT), within a planned timeframe in locally advanced squamous cell vulvar cancer impacts overall survival (OS). Methods: Women 18 years or older with FIGO stage II to IVA vulvar cancer who received external beam RT or CRT as part of their initial treatment course were identified from the National Cancer Database from 2004-2017. Patients with non-squamous cell carcinoma histology or who received systemic cytotoxic therapies as primary treatment were excluded. Patients who received less than 20 fractions of radiation were also excluded. Time to radiation completion was the number of days from the initiation to completion of radiation. The delay of radiation completion was calculated as the difference between the actual time to radiation completion and predicted duration of radiation. Types of treatment (RT and CRT) were both stratified into groups based on the delay of radiation completion, less than 7 days or greater than 7 days. Chi-square, Fisher Exact ANOVA and Kruskal-Wallis tests were used for analysis. Kaplan-Meier curves with log-rank tests were fit for univariate time-to-event analysis. Multivariable Cox proportional hazard models were fit to assess effects after controlling for confounding. Results: There were 2378 patients identified for analysis (n = 856 RT and n = 1522 CRT). Median age was 67 (IQR 56-78) and the CRT group was younger (p < 0.0001) than the RT group. The majority were white (88.35%) with advanced FIGO stage III or IVA (72.29 %) disease. Median dose of total radiation was 5720 cGy (IQR 5040-6300) with higher doses observed in the greater than 7 days delay group versus less than 7 days, (p < 0.0001). Median follow up was 27.2 (IQR 11.8-57.9) months. For both cohorts, completion of treatment with delay less than 7 days resulted in significant improvement in median survival when compared to treatment completion delay of more than 7 days: RT (Median OS 34.9 versus 21.6 months, p < 0.01) and CRT (58 versus 41.3 months, p < 0.01). On multivariate subset analysis, both completion of CRT and RT were associated with improved OS when treatment was completed with less than 7 days delay vs greater than 7 days delay, CRT (HR 0.869 [95%CI 0.758-0.997]), RT (HR 0.820 [95%CI 0.698-0.964]). Advanced FIGO stage IVA was associated with the greatest increase in hazard of death, (HR 1.758 [95%CI 1.516-2.039]), compared to FIGO stage II. Conclusions: Completion of radiation with less than 7 days delay is associated with improved overall survival, which is independent of concurrent chemotherapy. These findings suggest that strategies to minimize delays in radiation treatment are crucial in treating locally advanced vulvar cancer.

Surgical Treatment for Locally Advanced (T4) Squamous Cell Carcinoma of the Thoracic Esophagus

Dysphagia ◽  
2002 ◽  
Vol 17 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Mitsuo Tachibana ◽  
Dipok Kumar Dhar ◽  
Shoichi Kinugasa ◽  
Hiroshi Yoshimura ◽  
Muneaki Shibakita ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Surgical Treatment ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Thoracic Esophagus

scholarly journals Management of Advanced Squamous Cell Carcinoma of the Vulva Cancer

Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 167
Author(s):  
Linda J. Rogers
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Surgical Resection ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Management Strategies ◽  
Locally Advanced ◽  
Female Genital Tract ◽  
Lichen Sclerosus ◽  
Younger Women

Vulvar cancer is a rare gynaecological malignancy, accounting for 2–5% of cancers of the female genital tract. Squamous cell carcinoma is the most frequently occurring subtype and, historically, has been a disease of older post-menopausal women, occurring with a background of lichen sclerosus and other epithelial conditions of the vulvar skin that may be associated with well-differentiated vulvar intra-epithelial neoplasia (dVIN). An increase in human papillomavirus (HPV) infections worldwide has led to an increase in vulvar squamous carcinomas in younger women, resulting from HPV-associated high-grade vulvar squamous intra-epithelial lesions (vHSIL). Surgical resection is the gold standard for the treatment of vulvar cancer. However, as approximately 30% of patients present with locally advanced disease, which is either irresectable or will require radical surgical resection, possibly with a stoma, there has been a need to investigate alternative forms of treatment such as chemoradiation and targeted therapies, which may minimise the psychosexual morbidity of radical surgery. This review aims to provide an update on management strategies for women with advanced vulvar cancer. It is hoped that investigation of the molecular biologies of the two different pathways to vulvar squamous cell carcinoma (HPV-associated and non-HPV-associated) will lead to the development of targeted therapeutic agents.

Partial urethral resection in the surgical treatment of vulvar cancer does not have a significant impact on urinary continence. A confirmation of an authority-based opinion

2007 ◽  
Vol 17 (1) ◽  
pp. 294-297 ◽  
Author(s):  
Y De Mooij ◽  
M. P.M. Burger ◽  
M. S. Schilthuis ◽  
M. Buist ◽  
J. Van Der Velden
Keyword(s):  
Urinary Incontinence ◽  
Surgical Treatment ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Partial Resection ◽  
Urinary Continence ◽  
Control Group ◽  
Study Group ◽  
Partial Removal ◽  
Radical Vulvectomy

Partial resection of the urethra is sometimes necessary in the surgical treatment of locally advanced vulvar cancer. In this study, the frequency of urinary incontinence after partial urethral resection was compared with that of patients who were treated without partial resection of the urethra. Eighteen patients with vulvar cancer encroaching or infiltrating the urethra, treated by a radical vulvectomy and partial urethrectomy, were compared with 17 patients treated by vulvectomy without partial removal of the urethra. Data on urinary incontinence pre- and postoperatively from both groups were retrospectively collected from the patient files. A questionnaire on urinary incontinence was sent to a subset of patients from both groups in order to get information on the current micturation pattern. In four out of 18 patients (22%) with a partial urethrectomy, incontinence was reported, versus two out of 17 patients (12%) in the control group (P= 0.860). Eight patients in the study group and 12 in the control group are currently alive, and all responded to the questionnaire. Two (25%) in the study group and three (25%) in the control group reported to have current symptoms of urinary incontinence. This retrospective study shows that partial resection of 1–1.5 cm of the distal urethra in addition to a radical local excision for vulvar cancer does not result in a significant increase in the frequency of urinary incontinence, compared with vulvar cancer patients without partial urethrectomy.

scholarly journals Surgical treatment of locally advanced vulvar cancer

2021 ◽  
Vol 10 (3) ◽  
pp. 20-25
Author(s):  
A.  A. Mukhin ◽  
A.  V. Vazhenin ◽  
V.  V. Saevets ◽  
A.  V. Taratonov
Keyword(s):  
Surgical Treatment ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
Surgical Procedure ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Advantages And Disadvantages ◽  
Reconstructive Plastic Surgery ◽  
Reconstructive Techniques ◽  
Reconstructive Plastic

The article discusses the choice of different surgical procedures in patients with locally advanced vulvar cancer, depending on the volume of resected tissues and the possibility of reconstructive plastic surgery. The advantages and disadvantages of various plastic reconstructive techniques are provided. The issue of wound closing after the vulvectomy and the plastic techniques has always been controversial and led to the sophistication of the reconstructive component, as well as to the limitations or refusal of this surgical procedure use.

Tạo hình khuyết hổng trong phẫu thuật ung thư âm hộ: báo cáo 2 trường hợp tạo hình phức tạp và tổng quan y văn

2020 ◽  
Author(s):  
Lap Luong Chan
Keyword(s):  
Vulvar Cancer ◽  
Locally Advanced ◽  
Pedicled Flap ◽  
Diep Flap ◽  
Epigastric Artery ◽  
Vulvar Reconstruction ◽  
Deep Inferior Epigastric Artery ◽  
Reconstructive Techniques ◽  
Gracilis Myocutaneous Flap ◽  
Artery Perforator

Performing radical surgery for locally advanced vulvar cancer is usually associated with the occurrence of large perineal defects. These defects, especially in previously radiated cases, often require more advanced reconstructive techniques using locoregional flaps. We present two cases of vulvar reconstruction, one case using a split and thinned, transversely oriented, pedicled deep inferior epigastric artery perforator (DIEP) flap and another one with gracilis myocutaneous flap. These pedicled flap seems to be an effective and feasible method of perineal reconstruction after extended perineal resection for locally advanced vulvar cancers. especially in pre-irradiated patients.

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