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cancer (LAVC). In all cases, two teams performed the surgery: one for total radical vulvectomy and
the other for inguinofemoral lymphadenectomy. Surgical procedures started at the same time and
were performed according to standard triple incision technique. Postoperative complications
involving the surgical sites or lymphatic drainage were observed in one third of patients (19/57).
None of them required surgical re-intervention. After treatment 29 patients developed local, regional
or distant recurrence of disease, with a median progression-free survival of 39.5 ± 20.9 months.
Three-year and 5-year overall survival (OS) were of 60.5% and 48.6%, respectively.

9.2 Previous initiatives

Nine previous initiatives1-4,37-39,87,88 presenting guidelines surgical management were identified.

9.3 Development group comments

Vulvectomy in addition to radical local excision can be considered in tumours with extensive premalignant
disease to reduce the risk of local recurrence. Data on surgical margins are conflicting. Therefore, the
development group advises to consider narrow margins when this means clitoris/anus can be preserved.
Treatment of advanced stage vulvar cancer often involves multiple treatment modalities. Treatment planning is
often individualized in advanced stage and depends on primary tumour characteristics and presence of regional
and/or distant metastases. Also comorbidity and/or frailty of the patient influences treatment planning.
Therefore, a multidisciplinary setting is needed to optimize treatment planning.
In case of enlarged groin nodes either inguinofemoral lymphadenectomy followed by radiotherapy, or groin node
debulking followed by radiotherapy can be considered. When imaging shows enlarged pelvic nodes, debulking
of these nodes is recommended with adjuvant radiotherapy, since radiotherapy alone will probably not sterilize
large nodal pelvic disease.

 VULVAR CANCER - GUIDELINES 
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