Introduction/Background Treatment of vulvar cancer recurrence will depend on previous treatment. If the patient has already received radiotherapy, surgical rescue is the first option as long as distant metastasis has been ruled out. Complex surgeries such as Pelvic Exenteration (PE) should be assessed individually paying attention to the fragility of the patient. It’s vital to keep in mind that the central objective of PE is to achieve a complete resection. The term ‘composite PE’ denotes a procedure that melds exenteration with pelvic bone resection. This technique could facilitate complete removal of the tumor. Usually it doesn’t pose technical challenges and it doesn’t compromise pelvic girdle stability.

Methodology This case involves a woman diagnosed in 2015 with squamous cell carcinoma of the vulva after biopsy of a lesion on the left labia majora. Tumorectomy was performed.

In 2018 she suffered 1st recurrence in the right part of the vulva. Partial vulvectomy was performed with adjuvant radiotherapy.

In 2019 she suffered 2nd recurrence on previous surgical bed. At this point she was reffered to our hospital. In the complementary studies, the MRI showed the tumor in contact with the right lateral edge of the urethra. PET-TC showed one suspicious right inguinal adenopathy. There were no signs of distant metastatic disease.

She underwent a composite total pelvic exenteration in which part of superior ramus of pubis and the isquium was removed. Also a double bar wet colostomy was performed. A right extended VRAM flap was made as reconstruction.

Results The surgery achieved complete resection of the tumor.

One year follow up of the patient have been completely up to now.

Conclusion This case highlights the potential benefits of pubic bone resection in order to achieve ‘no residual disease’.

The case presentation was carried out with informed consent and ensuring the preservation of the patient‘s anonymity.

Disclosures This video did not receive any financial support. Authors declare no competing of interest.