title: Does plastic surgical consultation improve the outcome of patients undergoing radical vulvectomy for squamous cell carcinoma of the vulva?
abstract: OBJECTIVE
  To analyze margin status and prognostic factors for complications in patients undergoing vulvectomy for invasive squamous cell cancer (iSCC) with and without plastic-assisted closure.
  
  
  METHODS
  Demographic and clinical data were collected on 94 patients with iSCC who underwent vulvectomy between 2004 and 2013. All pathology slides were re-reviewed by two gynecologic pathologists. Data were analyzed using XLSTAT-Pro v2014.2.02.
  
  
  RESULTS
  Of 88 eligible patients, 15 (17%) had plastic-assisted vulvar closure and 73 (83%) did not. There were significantly more patients in the plastics group with recurrent disease (53% v 10%) and history radiation therapy prior to surgery (40% versus 5%). Plastic-assisted closure was associated with larger tumors (3.73 cm versus 2.03 cm, p<0.01) and a higher frequency of adequate margins (53% versus 29%, p=0.06). For tumors≥3.0 cm, plastic-assisted closure was significantly associated with adequate margins (44% versus 6%, p=0.03). Prior radiation use was associated with plastic-assisted closure, larger tumors, older age, and recurrent disease. Complications occurred in 36 patients (41%) and significantly more occurred in those with plastic-assisted closure (67% versus 36%, p=0.04). On multivariate analysis including age, tumor size, recurrent disease, plastic-assisted closure, and history of radiation, only history of radiation therapy was a significant predictor of complications (OR=17, 95%CI 2.05-141.35; p=0.01).
  
  
  CONCLUSIONS
  Plastic-assisted vulvectomy closure was more often utilized in cases involving past radiation therapy and larger tumors. Plastic-assisted closure significantly increased the frequency of adequate margins in tumors≥3 cm and did not impact complications.
authors: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA. Electronic address: eaviki@partners.org.
authors: Emeline M
authors: EM
authors: Aviki
authors: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA.
authors: Katharine M
authors: KM
authors: Esselen
authors: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA.
authors: Sara M
authors: SM
authors: Barcia
authors: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA.
authors: Marisa R
authors: MR
authors: Nucci
authors: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA.
authors: Neil S
authors: NS
authors: Horowitz
authors: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA.
authors: Colleen M
authors: CM
authors: Feltmate
authors: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA.
authors: Ross S
authors: RS
authors: Berkowitz
authors: Department of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA.
authors: Dennis G
authors: DG
authors: Orgill
authors: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA.
authors: Akila N
authors: AN
authors: Viswanathan
authors: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medicine School, Boston, MA, USA.
authors: Michael G
authors: MG
authors: Muto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Complications; Plastics surgery; Squamous cell cancer; Tumor margins; Vulvar cancer; Vulvectomy