You are here

Article Text

Article menu
Download PDFPDF
Original research
Role of V-Y flap reconstruction in vulvar cancer patients: multicenter retrospective study
  1. Violante Di Donato1,
  2. Andrea Giannini1,
  3. Valerio Galli1,
  4. Mariano Catello Di Donna2,
  5. Mario Antonio Congiu3,
  6. Giorgia Garganese4,5,
  7. Francesco Plotti6,7,
  8. Flavia Sorbi8,
  9. Tullio Golia D'Augè1,
  10. Antonio Simone Laganà9,10,
  11. Stefano Gentileschi11,12,
  12. Anna Amelia Caretto12,
  13. Ilaria Cuccu1,
  14. Francesca Falcone13,
  15. Mario Malzoni13,
  16. Enzo Ricciardi14,
  17. Giorgia Perniola1,
  18. Camilla Turetta1,
  19. Helmut Plett15,
  20. Massimiliano Fambrini8,
  21. Vito Chiantera2,10,
  22. Enrico Vizza16,
  23. Roberto Angioli6,
  24. Francesco Raspagliesi17,
  25. Ludovico Muzii1,
  26. Giovanni Scambia4,5,
  27. Pierluigi Benedetti Panici1 and
  28. Giorgio Bogani17
    1. 1 Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, Rome, Italy
    2. 2 Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione “G. Pascale”, Naples, Italy
    3. 3 Chirurgien gynéco-oncologique Clinique Champeau Méditerranée et Clinique Causse Béziers et Colombiers, Beziers, France
    4. 4 Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
    5. 5 Dipartimento Scienze della Vita e Sanità Pubblica, Sezione Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
    6. 6 Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
    7. 7 Division of ob/gyn, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy
    8. 8 Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
    9. 9 Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Palermo, Italy
    10. 10 Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
    11. 11 Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
    12. 12 Department of Plastic Surgery, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
    13. 13 Malzoni Research Hospital, Avellino, Italy
    14. 14 Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Ospedale Sandro Pertini, Rome, Italy
    15. 15 Department of Gynecology with Center for Oncological Surgery, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
    16. 16 Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Institute, Rome, Italy
    17. 17 Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
    1. Correspondence to Dr Violante Di Donato, Department of Gynecological, Obstetric, and Urological Sciences, University of Rome La Sapienza, Rome, Lazio 00161, Italy; violante.didonato{at}uniroma1.it

    Abstract

    Objective To assess if the use of a V-Y reconstructive flap after excisional radical surgery positively influences the surgical outcomes in patients with vulvar cancer.

    Methods This was a multicenter, retrospective, controlled study. Surgical outcomes and complication rates of women with invasive vulvar cancer who underwent radical surgery and vulvar reconstruction and those who underwent radical surgery without the reconstruction step were compared. Only patients who underwent bilateral or unilateral V-Y advancement fascio-cutaneous flaps were included in the reconstruction group. Univariate and multivariate logistic regression models were used to analyze predicting variables for their association with complication rates.

    Results Overall, 361 patients were included: 190 (52%) underwent the reconstructive step after the excisional radical procedure and were compared with 171 (47.4%) who did not undergo the reconstructive step. At multivariate analysis, body mass index >30 kg/m2 (odds ratio (OR) 3.36, p=0.007) and diabetes (OR 2.62, p<0.022) were independently correlated with wound infection. Moreover, increasing age (OR 1.52, p=0.009), body mass index >30 kg/m2 (OR 3.21, p=0.002,) and International Federation of Gynecology and Obstetrics (FIGO) stages III–IV (OR 2.25, p=0.017) were independent predictors of wound dehiscence. A significant reduction in the incidence of postoperative wound complications among patients who underwent V-Y reconstructive flaps was demonstrated. This was correlated more significantly in women with lesions >4 cm.

    Conclusions The adoption of V-Y flaps in vulvar surgery was correlated with reduced surgical related complications, particularly in vulnerable patients involving large surgical defects following excisional radical procedures.

    • Vulvar and Vaginal Cancer
    • Surgical Flaps
    • Quality of Life (PRO)/Palliative Care
    • Postoperative complications
    • Gynecologic Surgical Procedures

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2024-005486

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      Data availability statement

      Data are available upon reasonable request.

      View Full Text

      Footnotes

      • X @BoganiGiorgio

      • Contributors Conception and design of the study: GB, VDD, and GP. Methodology: GG, AAC, and ER. Project administration: AG, ASSL, and MAC. Supervision: PBP, FR, GS, VC, EV, and MF. Patient recruitment: LM, MAC, VC, EV, FR, LM, GS, HP, RA, and MM. Analysis of the data and interpretation: FP, FS, SG, FF, and MCDD. Writing–original draft: TGDA, VG, IC, and CT. Writing–review and editing: TGDA. VDD is responsible for the overall content as the guarantor. All authors read and approved the final manuscript.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.