Page 8 - ESGO - Vulvar cancer - Complete report_fxd2

 Further staging with CT thorax/abdomen and pelvis is recommended where there is a clinical suspicion
of, or proven nodal) metastatic disease and/or advanced stage disease.

 The pathology report on preoperative biopsy should at least include histological type and depth of
invasion.

5.4 Surgical management

Local treatment

C Radical local excision is recommended.
 Consider additional, more superficial resection of differentiated vulvar intraepithelial neoplasia d -

VIN) in addition to radical local excision of invasive tumours.
 In multifocal invasive disease radical excision of each lesion as a separate entity may be considered.

Vulvectomy may be required in cases with multifocal invasion arising on a background of extensive
vulvar dermatosis.
 The goal of excision is to obtain tumour-free pathological margins. Surgical excision margins of at
least 1 cm are advised. It is acceptable to consider less wide margins where the tumour lies close to
midline structures clitoris, urethra, anus and prese rvation of their function is desired.
 When invasive disease extends to the pathological excision margins of the primary tumour, reexcision
is treatment of choice.
 Advanced stage patients should be evaluated in a multidisciplinary setting to determine the optimal
choice and order of treatment modalities.

Groin treatment

C Groin treatment should be performed for tumours > pT1a.

B For unifocal tumours < 4 cm without suspicious groin nodes on clinical examination and imaging any
modality the sentinel lymph node procedure is recommended.

C For tumours ≥ 4 cm and/or in case of multifocal invasive disease inguinofemoral lymphadenectomy by
separate incisions is recommended. In lateral tumours medial border > 1 cm from midline ipsilateral
inguinofemoral lymphadenectomy is recommended. Contralateral inguinofemoral lymphadenectomy
may be performed when ipsilateral nodes show metastatic disease.

D When lymphadenectomy is indicated, superficial and deep femoral nodes should be removed.

C Preservation of the saphenous vein is recommended.
 The optimal management of the groin full inguinofemoral lymphadenectomy or isolated removal

only for enlarged, proven metastatic nodes remains to be defined.
 Where enlarged > 2 cm pelvic nodes are identified, their removal should be considered.

Reconstructive surgery

 Availability of reconstructive surgical skills as part of the multidisciplinary team is required in early as
well as advanced stage disease.

 VULVAR CANCER - GUIDELINES 
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