Advanced vulvar carcinoma: is it worth operating? A perioperative management protocol for radical and reconstructive surgery.
OBJECTIVE
The aim of this study was to characterize the means whereby the results could be improved and the morbidity and side-effects minimized, of radical and extensive surgery performed together with plastic reconstruction, in the treatment of locally advanced and relapsed vulvar carcinoma.


METHODS
Between May 2000 and November 2004, twenty-three patients with locally advanced or relapsed vulvar carcinoma underwent major radical or extended vulvectomy, requiring reconstructive surgery. A consistent protocol for the perioperative management of these patients, including precautionary measures to reduce the rate of early complications, was introduced in the second study period (from November 2003) to verify the benefit on surgical outcome.


RESULTS
An analysis of the medical reports showed an improvement in the median time of the postoperative course and related morbidity as a consequence of a strict application of the management protocol, with consequent decrease of early complications.


CONCLUSIONS
Reconstructive surgery, which broadens the spectrum of available operative therapy in primary and locally recurrent vulvar cancer, is characterized by a high complication rate. The application of a strict perioperative protocol could reduce the number and the clinical impact of such complications.
Fanfani
Francesco
F
Department of Oncology, Division of Gynecologic Oncology, Catholic University of Sacred Heart, Campobasso, Italy.
Garganese
Giorgia
G
Fagotti
Anna
A
Lorusso
Domenica
D
Gagliardi
Maria Lucia
ML
Rossi
Marco
M
Salgarello
Marzia
M
Scambia
Giovanni
G
D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D019990:Perioperative Care; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D014846:Vulvar Neoplasms / Q000601:surgery*