title: Two-team simultaneous total radical vulvectomy and inguino-femoral lymphadenectomy via separate incisions for locally advanced (FIGO stages IB ≥ 4 cm-III) squamous vulvar cancer.
abstract: OBJECTIVE
  To describe the feasibility, safety, and oncological outcomes of a modified triple-incision total radical vulvectomy and inguino-femoral lymphadenectomy in patients with locally advanced squamous vulvar cancer.
  
  
  METHODS
  A modified triple-incision technique performed by two surgical teams operating simultaneously under regional anesthesia was performed on a consecutive series of 57 patients with Fédération Internationale de Gynécologie Ostétrique (FIGO) stages IB ≥ 4 cm to III squamous vulvar cancer. Adjuvant radiation therapy was delivered according to margin status and groin involvement. Surgical outcomes and follow-up data were retrospectively analyzed.
  
  
  RESULTS
  The mean age of patients was 75.5 ± 10.7 years and 54 (94.7%) had at least one comorbidity. Fifteen (26.3%) had disease of clinical FIGO stage I ≥ 4 cm, 7 (12.3%) had stage II, and 35 (61.4%) had a stage III. All surgical procedures were completed as planned. The mean surgical duration was 108 ± 37 min. Major intraoperative complications were observed in two cases (3.5%). Twenty-one (36.8%) patients received adjuvant radiation therapy. During a mean follow-up of 51.6 ± 50.5 months, 29 (50.9%) patients developed local, regional or distant recurrence. The disease-free survival was 39.5 ± 20.9 months. Nineteen (33.3%) patients died of primary disease. Overall survival for the entire cohort was 65.4%, with 3-year and 5-year overall survival of 60.5% and 48.6%, respectively.
  
  
  CONCLUSIONS
  Our results seem to reveal that the procedure is safe, with surgical and oncological outcomes comparable to classic sequential triple-incision technique. The shortening of surgical duration along with the use of regional anesthesia can have significant advantages for perioperative care, reducing the global burden of treatment and increasing the number of patients eligible for therapeutic surgery.
authors.affiliation: Department of Gynecology and Obstetrics, University of Florence, Florence, Italy maxfambrini@libero.it.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fambrini
authors.affiliation: Department of Gynecology and Obstetrics, University of Florence, Florence, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Sorbi
authors.affiliation: Department of Gynecology and Obstetrics, University of Florence, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sisti
authors.affiliation: Department of Gynecology and Obstetrics, University of Florence, Florence, Italy.
authors.forename: Vanni
authors.initials: V
authors.lastname: Checcucci
authors.affiliation: Department of Gynecology and Obstetrics, University of Florence, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cariti
authors.affiliation: Department of Radiation-Oncology, University of Florence, Florence, Italy.
authors.forename: Vieri
authors.initials: V
authors.lastname: Scotti
authors.affiliation: Department of Gynecology and Obstetrics, University of Florence, Florence, Italy.
authors.forename: Elettra
authors.initials: E
authors.lastname: Tinacci
authors.affiliation: Department of Gynecology and Obstetrics, University of Florence, Florence, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Turrini
authors.affiliation: Department of Anesthesiology University of Florence, Florence, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Micaglio
authors.affiliation: Department of Gynecology and Obstetrics, University of Florence, Florence, Italy.
authors.forename: Angelina
authors.initials: A
authors.lastname: De Magnis
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D014844:Vulva / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*
keywords: Vulvar cancer; lymphadenectomy; radical vulvectomy; regional anesthesia; separate incisions; simultaneous