VULVAL SURGERY IN INVASIVE VULVAL CANCER

The standard radical mutilating surgery for the treatment of invasive vulval carcinoma has been replaced by the unanimously accepted conservative and individualized approach. Current safe surgical conservative modifications in terms of vulval lesion management are separate skin vulval–groin incisions, drawn according to the lesion diameter, and wide local radical excision or partial radical vulvectomy with 1–2cm of clinically clear surgical margins. In terms of inguinofemoral lymph-node management, surgical conservative modifications that do not compromise patient survival are: omission of groin lymphadenectomy only when tumor stromal invasion is ≤1mm; unilateral groin lymphadenectomy only in highly lateralized early lesions; and total or radical inguinofemoral lymphadenectomy with preservation of femoral fascia when full groin resection is needed. Sentinel lymph-node dissection is a promising technique, but it should still be considered an experimental procedure that should not be routinely employed by average operators outside referral centers.