title: T2/3 vulva cancer: a case-control study of triple incision versus en bloc radical vulvectomy and inguinal lymphadenectomy.
abstract: The purpose of this case-control study was to compare outcome in T2/3 vulvar cancer patients treated with radical vulvectomy and inguinal lymphadenectomy using either a triple incision or en bloc technique. All T2/3 vulvar cancer patients treated by the triple incision technique were identified and compared to a control group consisting of similar T2/3 patients treated with an en bloc procedure at the same institution. Survival by surgical stage, lesion diameter, nodal status, and margin status was analyzed and compared between the two groups. Twenty-seven vulvar cancer patients with a T2/3 lesion underwent radical vulvectomy and inguinal lymphadenectomy using the triple incision technique; the control group consisted of 20 T2/3 vulvar cancer patients treated by en bloc resection. The two groups were matched for age, surgical stage, grade, lesion diameter, margin status, nodal status, and adjuvant treatment. The recurrence rate in the triple incision group was 37% compared to 35% in the en bloc group. (OR, 1.092, 95% CI, [0.327, 3.649], P = 0.9). There was no difference in the local recurrence rate between the two groups (80% in the triple incision group and 72% in the en bloc group) (P = 0.5). Five-year survival for the triple incision and the en bloc groups was similar, 64 and 82%, respectively (P = 0.15). Survival between the groups was not statistically different when analyzed according to surgical stage, lesion diameter, nodal status, and negative margin status. These data indicate that the triple incision technique provides survival outcomes similar to the standard en bloc radical vulvectomy in patients with T2/3 vulva cancer. Due to the significant morbidity that has been associated with the en bloc radical vulvectomy and inguinal lymphadenectomy, the triple incision technique should be considered as the preferred method of treatment for most vulvar cancer patients.
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham 35233-7333, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Siller
authors.forename: R D
authors.initials: RD
authors.lastname: Alvarez
authors.forename: W D
authors.initials: WD
authors.lastname: Conner
authors.forename: C H
authors.initials: CH
authors.lastname: McCullough
authors.forename: L C
authors.initials: LC
authors.lastname: Kilgore
authors.forename: E E
authors.initials: EE
authors.lastname: Partridge
authors.forename: J M
authors.initials: JM
authors.lastname: Austin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000601:surgery*; D016022:Case-Control Studies; D004210:Dissection; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D014844:Vulva / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000453:epidemiology / Q000601:surgery*