Introduction/Background Management of recurrent vulvar cancer involving the femoral artery after primary surgery and irradiation is challenging. Few case reports exist describing surgical management of advanced recurrent vulvar cancer in the groin region in the context of limb salvage.
Methodology A 60 years old female who underwent a left hemivulvectomy at another institution 1 year earlier for vulvar squamous cell carcinoma. The patient was diabetic, hypertensive and had left hemiplegia. Two months later, local recurrence occurred in the left inguinal lymph nodes and was treated by bilateral inguinal lymphadenectomy and adjuvant radiotherapy. Amidst her radiotherapy course, she refused to continue treatment. The following year, she presented to our institution with a large infected necrotic fungating recurrence in the left groin region. Evaluation by a multidisciplinary team revealed a 15 × 7 cm left inguinal mass infiltrating the ipsilateral superior pubic ramus, inguinal ligament and encasing the external iliac and femoral vessels. The family was counselled about urgent palliative surgery for possibility of femoral vessels blow out.
Results Surgery was performed by a team of gynecologic oncologists, vascular, orthopedic, general and reconstructive surgeons. It entailed enbloc radical excision of the tumor with safety margins including excision of the superior pubic ramus. The femoral vessels were dissected from the lateral border of the tumor. Partial reconstruction of the soft tissue defect was done by a right rectus abdominus muscle flap to cover the exposed major vessels. Estimated blood loss was 1600 ml and operative time was 10 hours. The patient survived postoperatively and was stable but at 3 weeks she deteriorated quickly and died of septic shock.
Conclusion Tumor resection for patients with recurrence of vulvar cancer in the groin region involving the femoral artery after primary surgery and pelvic irradiation is a complex yet feasible palliative surgical option, thus avoiding classic hemipelvectomy.
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