Introduction/Background*Pelvic exenteration may be necessary for some patients with primary locally advanced or recurrent vulvar cancer. The procedure is associated with significant morbidity and mortality and requires highly specialized surgical skills as well as careful patient selection. In Norway, the procedure is largely centralized to Oslo University Hospital (OUH). Few case series have been published to date.
Methodology This single center retrospective study included patients treated with pelvic exenteration for primary locally advanced or recurrent vulvar cancer between 1995 and 2019 at OUH, Norway. Complications were coded according to the contracted Accordion classification. Descriptive statistics were used. Follow up time was calculated with the Inverse Kaplan Meyer method. Progression free survival (PFS) and overall survival (OS) were estimated with the Kaplan Meyer method.
Result(s)*31 patients were followed for a median of 4.94 years (95%CI: 3.37-NR). 55% were exenterated for a primary vulvar cancer, and 45% had recurrent vulvar cancer. 19% underwent anterior, 19% posterior, 32% modified posterior and 29% total exenteration. Histopathological free margins were achieved in 28 (90%) of the patients. Four (13%) patients received adjuvant treatment due to lymph node metastasis at the time of exenteration. The 90 days morbidity for grade 3 complications was 61%, while 10% had no complications. The 90 days mortality rate was 3%. 16 patients (52%) relapsed, and more than half of the recurrences were localized in the pelvis (4 of 17 patients with primary vulvar cancer; 6 of 14 patients with relapsed vulvar cancer). During follow up, 18 (58%) patients died, 11 of those from vulvar cancer. Median PFS and OS were 3.12 years (95% CI: 1.19-NR) and 4.87 years (95%CI: 1.74-9.00) respectively. Three-year PFS and OS were 50% (95% CI 31-67%) and 60% (95%CI: 40-75%), respectively.
Conclusion*Acceptable oncologic outcomes after pelvic exenteration for primary and recurrent vulvar cancer can be achieved if surgery is centralized. Still, the procedure is associated with considerable morbidity and high risk of relapse. Despite the exceptionally high rate of free margins, the majority of relapses were localized to the pelvis, in particular among patients with relapsed disease. Improved outcomes may be achieved with incorporation of biomarkers beyond clinical characteristics for selection, as well as consideration of multimodal treatment.
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