Limited resection of some
vulvar cancers may provide cure rates equivalent to those obtained with radical
vulvectomy and bilateral inguinal node dissection. Rapid recovery, fewer complications, and better functional result have been described as advantages to less extensive procedures. Since 1978, 32 patients with invasive
squamous cell cancer of the vulva (depth greater than 1 mm) and clinically negative inguinal lymph nodes underwent radical wide excisions as primary
therapy. Mean age at diagnosis was 61 years. Seventeen patients had T1 and 15 had T2
tumors. Resection of the primary lesion was tailored to lesion location and size, and dissection was carried to the deep perineal fascia. Twenty-two patients had unilateral superficial inguinal
lymph node dissections, five with midline lesions had bilateral superficial dissections, and five had node samplings which included deep inguinal nodes. Depth of invasion ranged from 1.5 to 13.0 mm. Mean largest lesion dimension was 23 mm. Five-year lifetable survival for the entire group was 84%. Univariate analysis of potential prognostic variables showed no significant recurrence or survival differences for patient age (P = 0.56), symptom duration (P = 0.57), FIGO stage (P = 0.67),
tumor grade (P = 0.20),
tumor location (P = 0.26), depth of invasion (P = 0.56), or
resection margin status (P = 0.63). Thirty-one percent of patients had perioperative complications, and 16% developed delayed complications. Mean
hospital stay was 10 days. Three patients (10%) developed new or recurrent
vulvar disease and underwent additional
therapy. None have died of disease, although one is alive with persistent
tumor. Radical wide excision and selective inguinal
lymphadenectomy constitute a reasonable alternative to radical
vulvectomy with bilateral inguinal node dissections for squamous
tumors clinically limited to the vulva. Outcome may not be strongly influenced by lesion size or depth of invasion.