Operationssaal mit Schere im Vordergrund.

Reconstructive Surgery versus Primary Closure following Vulvar Cancer Excision: A Wide Single-Center Experience


Mus­ta­fa Zel­al Mual­lem 1Jalid Seh­ouli 1Andrea Miran­da 1Hel­mut Plett 1Ahmad Say­as­neh 2Yas­ser Diab 3Juma­na Mual­lem 1Imad Hato­um 1

Simple Summary

When it comes to advan­ced vul­val can­cer manage­ment, the­re is a cri­ti­cal quan­da­ry to con­sider. This is owing to the seve­re nega­ti­ve impact of demo­li­ti­ve sur­gery on women who are aff­lic­ted by both func­tion­al and psy­cho­lo­gi­cal con­se­quen­ces of the pro­ce­du­re. Pri­ma­ry clo­sure of vul­var and/or peri­ne­al defects can be accom­plished wit­hout dif­fi­cul­ty in many situa­tions, but this is accom­pa­nied by ten­si­on of the skin clo­sure and dis­tor­ti­on of the ana­to­my. In the­se cir­cum­s­tances, recon­s­truc­ti­ve sur­gery will be requi­red to res­to­re the ana­to­mic­al and func­tion­al cha­rac­te­ristics of the vul­va. In this paper, we share our sub­stan­ti­al exper­ti­se of pri­ma­ry clo­sure ver­sus recon­s­truc­tion after demo­li­ti­ve sur­gery of advan­ced vul­var can­cer, and we dis­cuss our fin­dings in light of the literature.


(1) Back­ground: pla­s­tic recon­s­truc­tion in vul­var sur­gery can lead to a bet­ter tre­at­ment out­co­me than pri­ma­ry clo­sure. This stu­dy aims to compa­re the pre­ope­ra­ti­ve para­me­ters (co-mor­bi­di­ties and tumor size) and post­ope­ra­ti­ve results (tumor free mar­gins and wound heal­ing) bet­ween the pri­ma­ry clo­sure and recon­s­truc­ti­ve sur­gery after vul­var can­cer sur­gery; (2) Methods: this is a retro­s­pec­ti­ve ana­ly­sis of pro­s­pec­tively coll­ec­ted data from 2009 to 2021 at a ter­tia­ry can­cer insti­tu­ti­on; (3) Results: 177 pati­ents were included in the final ana­ly­sis (51 pati­ents had pri­ma­ry clo­sure PC and 126 had recon­s­truc­ti­ve sur­gery RS). About half (49%) of the PC pati­ents had no co-mor­bi­di­ties (p = 0.043). The RS group had a 45 mm medi­an maxi­mal tumor dia­me­ter com­pared to the PC group’s 23 mm (p = 0.013). More than 90% of RS and 80% of PC had tumor-free mar­gins (p = 0.1). Both groups had ante­rior vul­var excis­i­on as the most com­mon sur­gery (52.4% RS vs. 23.5% PC; p = 0.001). Both groups had iden­ti­cal rates of wound heal­ing dis­or­ders. In a medi­an fol­low-up of 39 months; recur­rent dise­a­se was found in 23.5% of PC vs. 10.3% in RS (p = 0.012). In terms of over­all sur­vi­val the­re was no signi­fi­cant dif­fe­rence bet­ween the both groups; (4) Con­clu­si­ons: recon­s­truc­ti­ve vul­var sur­gery enables enhan­ced com­ple­te resec­tion rates of lar­ger vul­var tumors with bet­ter ana­to­mic­al res­to­ra­ti­on and a com­pa­ra­ble wound reco­very in com­pa­ri­son to pri­ma­ry clo­sure. This results in a lower recur­rence rate despi­te the increased tumor volume.


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