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Radical vulvectomy


Medical editor Claes Tropè MD
Gynecological Oncologist
Oslo University Hospital

General

Guidelines

Resection of the primary tumor      

    • Resect with free margins of 2 cm. The shape of the resection depends on the localization of the tumor. Size/localization of the primary tumor may require plastic surgery.
    • If there is invasion of, or short distance to the sphincter, surgery may require extirpation of the anus and preparation of sigmoid-stoma. Primary radiation therapy is then an alternative.  
    • If there is invasion of, or short distance to the urethra, it is possible to resect up to 2 cm of the urethra. For larger resections, confer with a urologist. Primary radiation is an alternative.

    Stage 1a

      • Local excision with free margins of at least 2 cm
      • Extirpation of lymph nodes is not performed    

Extirpation of lymph nodes

Patients with stage Ib tumors are offered treatment with the sentinel node-technique.

All others:

  • Lateral localized stage Ib tumor.
    • Ipsilateral ingiunal surgery. If positive ipsilateral lymph nodes are found, a contralateral ingiuinal operation is performed.
  • Medial localized tumor (clitoris, perineum, anterior inner labia):
    • Bilateral inguinal lymph node dissection

If suspect lymph nodes are found by preoperative clinical examination or MRI, a fine needle aspiration is done for a cytological examination. 

If metastasis is confirmed, the surgery is limited to removing the enlarged lymph node(s). This is done to expedite healing and to reduce the risk for later lymph edema. The patient is then given postoperative radiation therapy.

 


Equipment

General surgery tray


Preparation

  • Shave the operation field
  • Spinal anesthesia

Implementation

  • Mark the area to be resected.
  • Resect the vulva.
  • Remove the specimen en bloc.  
  • Suture the wound edges in a way that provides enough space for the introitus.  
  • Insert a urinary catheter.
  • Insert a tamponade with estrogen if needed. (Ovesterin® 0,1%)  
  • Secure the specimen to a cork surface.

Follow-up

  • A possible tampon is removed after one day.
  • The Foley catheter is removed after 5-7 days.
  • Due to the danger of wound rupture right after surgery, the patient should not sit or spread her legs. 
  • As soon as possible postoperatively, the patient should start to dilate the vagina with a glass probe. 
  • The sutures are removed after about 2 weeks.

Complications 

  • Wound rupture
  • Infection

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