Pelvic exenteration for vulvar cancer: Postoperative morbidity and oncologic outcome - A single center retrospective analysis

H Valstad; B Eyjolfsdottir; Y Wang; G B Kristensen; T Skeie-Jensen; K Lindemann

doi:10.1016/j.ejso.2023.06.010

Pelvic exenteration for vulvar cancer: Postoperative morbidity and oncologic outcome - A single center retrospective analysis

Eur J Surg Oncol. 2023 Sep;49(9):106958. doi: 10.1016/j.ejso.2023.06.010. Epub 2023 Jun 13.

Authors

H Valstad¹, B Eyjolfsdottir², Y Wang², G B Kristensen³, T Skeie-Jensen², K Lindemann⁴

Affiliations

¹ Department of Gynecological Oncology, Division of Cancer Medicine, Oslo University Hospital, PB 4953, Nydalen, 0424, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, P.O Box 1171, Blindern, 0318, Oslo, Norway.
² Department of Gynecological Oncology, Division of Cancer Medicine, Oslo University Hospital, PB 4953, Nydalen, 0424, Oslo, Norway.
³ Department of Gynecological Oncology, Division of Cancer Medicine, Oslo University Hospital, PB 4953, Nydalen, 0424, Oslo, Norway; Institute for Cancer Genetics and Informatics, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
⁴ Department of Gynecological Oncology, Division of Cancer Medicine, Oslo University Hospital, PB 4953, Nydalen, 0424, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, P.O Box 1171, Blindern, 0318, Oslo, Norway. Electronic address: klinde@ous-hf.no.

PMID: 37349160
DOI: 10.1016/j.ejso.2023.06.010

Abstract

Background: Pelvic exenteration may be the only curative treatment for some patients with primary advanced or recurrent vulvar cancer but is associated with high morbidity. This study evaluated the clinical outcome of patients treated at a centralized service in Norway.

Methodology: This retrospective study included patients treated with pelvic exenteration for primary locally advanced or recurrent vulvar cancer between 1996 and 2019 at Oslo University Hospital, Norway. Complications were coded according to the contracted Accordion classification. Relapse free survival (RFS), cancer specific survival (CSS) and overall survival (OS) were estimated with the Kaplan Meier method.

Results: The 30 patients were followed for a median of 4.94 years (95%CI: 3.37-NR). Exenteration due to primary vulvar cancer was carried out in 16 (53%) patients, 14 (47%) had recurrent vulvar cancer. Free histopathological margins were achieved in 28 (93%) patients. The 90 days morbidity for grade 3 complications was 63%, predominantly wound/surgical flap infections, 7% had no complications. 90 days mortality was 3%. Five-year RFS was 26% (95% CI 8-48%), OS was 50% (95%CI: 29-69%) and CSS was 64% (95% CI 43-79%). There was no significant difference in survival between patients with primary vs recurrent disease. The 3-year CSS for patients with negative lymph nodes and positive lymph nodes was 70% (95% CI 47-84%) and 30% (95% CI 1-72%), respectively.

Conclusions: Acceptable oncologic outcomes after pelvic exenteration for primary and recurrent vulvar cancer can be achieved if surgery is centralized. Careful patient selection is imperative due to significant postoperative morbidity and considerable risk of relapse.

Keywords: Cancer-specific survival; Overall survival; Pelvic exenteration; Postoperative morbidity; Relapse-free survival; Vulvar cancer.

MeSH terms

Female
Humans
Morbidity
Neoplasm Recurrence, Local / epidemiology
Neoplasm Recurrence, Local / surgery
Pelvic Exenteration* / methods
Postoperative Complications / etiology
Retrospective Studies
Treatment Outcome
Vulvar Neoplasms* / pathology
Vulvar Neoplasms* / surgery