title: Advanced vulvar carcinoma: is it worth operating? A perioperative management protocol for radical and reconstructive surgery.
abstract: 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.
authors.affiliation: Department of Oncology, Division of Gynecologic Oncology, Catholic University of Sacred Heart, Campobasso, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.forename: Giorgia
authors.initials: G
authors.lastname: Garganese
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Gagliardi
authors.forename: Marco
authors.initials: M
authors.lastname: Rossi
authors.forename: Marzia
authors.initials: M
authors.lastname: Salgarello
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: 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*