Abstract EP1147 Table 1

Summary of case reports involving limb preserving procedures for vulvar cancer groin recurrence

Author (year) Age (years) Medical comorbidities Primary tumor therapy FIGO stage (initial presentation) Management of Groin recurrence with limb preserving procedures Postoperative outcomes
Deppe et al (1984) 63 --- Radical vulvectomy and bilateral inguinal lymphadenectomy. II Radiation therapy and femoral blow-out was managed by external iliac-femoral bypass utilizing 6-mm expanded polytetrafluoroethylene vascular graft (PTFE). Persistence of right leg lymphedema 5 months after surgery
Chao et al (2001) 51 Diabetes mellitus, hypertension Radical vulvectomy and bilateral inguinal lymphadenectomy III Radical enbloc excision of tumor along with the involved femoral artery and vein followed by Gore-Tex vascular graft and rectus abdominis myocutaneous flap reconstruction. Occlusion of the grafted vessels occurred 21 months following surgery. Patient survived more than 48 months
Sevin et al (2001) 66 --- Excision and postoperative external beam radiation I Wide excision of the recurrence including resection of the pubic bone and adjacent muscles with extra-anatomic axillo-popliteal bypass. Wound closure by a myocutaneous flap from the contralateral rectus abdominis. Death 7 months later due to rapidly progressing pulmonary recurrence.
Pararajasingam et al (2001) 55 --- Vulvectomy and bilateral inguinal lymphadenectomy I Common femoral artery blow-out was managed by a bypass from the left external iliac artery to the superficial femoral artery using a 6-mm expanded polytetrafluoroethylene vascular graft (PTFE) after external iliac artery ligation. No early postoperative complications.
Kim et al (2008) 52 --- Right radical vulvectomy and bilateral inguinal lymphadenectomy I First groin recurrence was managed by excision, radiation and chemotherapy. Second recurrence was managed by resection and reconstruction with a right gracilis muscle flap. Third recurrence and femoral blow-out was managed by embolization coils and percutaneous endovascular stent-graft placement from the distal left external iliac artery to the left superficial femoral artery. Death from widely metastatic disease 3 months later.
Trompetas et al (2010) 50 --- Radical vulvectomy and bilateral inguinal lymphadenectomy with adjuvant radiotherapy III Palliative chemotherapy (Carboplatin and Gemcitabine). Femoral blow-out was managed by a combined open surgical and endovascular intervention with 2 stents deployed across the bifurcation of the common femoral artery into the profunda femoris artery. Death from progressive disease without further bleeding 3 months later.
Horta et al (2011) 68 Diabetes mellitus Radical vulvectomy with bilateral inguinal lymphadenectomy II Radical tumor excision, ligation and excision of the femoral vein over a length of 7 cm. Reconstruction of the defect with a contralateral vertical rectus abdominis musculocutaneous (VRAM) flap based on the inferior epigastric pedicle. No early postoperative complications.
Nassiri et al (2015) 50 --- Excision --- Bland endovascular embolization of the tumor as well as 3 vessel covered stent revascularization in the common femoral, superficial femoral and profunda femoral arteries. No early postoperative complications.
Abdelbadee et al (2019) 60 Diabetes mellitus, hypertension, cerebrovascular stroke Left hemivulvectomy I Recurrence initially managed by bilateral inguinal lymphadenectomy and postoperative radiation. Subsequent management by radical enbloc tumor excision including left superior pubic ramus and dissection of femoral vessels. Reconstruction was done by a right rectus abdominus muscle flap to cover the exposed major neurovascular bundle. Death 3 weeks later with septic shock.