Surgical interventions for early squamous cell carcinoma of the vulva.

BACKGROUND: Radical surgery has been standard treatment for patients with early vulvar cancer since mid century. Survival figures are excellent, but complication rates are high. Over the last two decades, surgical treatment has become more individualised in order to decrease complications in patients with limited disease. OBJECTIVES: To determine whether the effectiveness and safety of individualised treatment is comparable with that of more extensive (non-individualised) surgery. SEARCH STRATEGY: The cirteria set by the Cochrane Gynaecological Cancer Group were used. We searched Medline and Embase (last search on 16 November 1999) We used our own publication archives, based on a prospective handsearch of six leading relevant journalswhich was started in December 1986. Reference lists of identified studies, gynaecological cancer handbooks and conference abstracts were also used. SELECTION CRITERIA: Types of study: RCT's, case control and observational studies on the effectiveness of surgical treatment of vulvar cancer. TYPES OF PARTICIPANTS: patients with cT1N0M0 squamous cell carcinoma of the vulva. Types of interventions: local surgical treatment as well as regional lymph node dissection. Types of outcome measurements: overall, disease specific and disease free survival; treatment complications; quality of life issues. DATA COLLECTION AND ANALYSIS: The two reviewers independently assessed study quality and extracted data. MAIN RESULTS: Only two studies with a total of 94 participants were included in the review. Both were observational studies. None of the other eleven considered studies met the minimum criteria as set by the Cochrane Collaboration. From these two studies, it can be concluded that: 1. radical local excision is as safe as a radical vulvectomy; 2. An ipsilateral lymph node dissection is safe in patients with a well lateralised tumour, and 3. A superficial groin node dissection is not as safe as a full femoro-inguinal groin node dissection. The fourth question we intended to answer is of great clinical importance: is the triple incision technique as safe as an en bloc dissection? This question could only be answered by using some of the unselected studies. From these studies, the triple incision technique appears to be as safe as the en bloc technique. REVIEWER'S CONCLUSIONS: The available evidence regarding surgical treatment of early vulvar cancer is generally of poor quality. From the evidence with sufficient quality we conclude that radical local excision, ipsilateral lymph node dissection in lateral tumors and triple incision technique are safe treatment options for early vulvar cancer. However, superficial groin node dissection results in an excess of groin recurrences compared to a full femoro-inguinal groin node dissection.