Post-Operative Complications Following Vulval Cancer Surgery: A Retrospective Study from a Gynaecologic Oncology Department

• Published in: Indian journal of gynecologic oncology 2024-09, Vol.22 (3), Article 107
• Main Authors: Punneshetty, Sahana, Thomas, Vinotha, Thomas, Dhanya Susan, Sebastian, Ajit, Chandy, Rachel George, Thomas, Anitha
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Oncology; Original Article; Surgical Oncology
• ISSN: 2363-8397; 2363-8400
• DOI: 10.1007/s40944-024-00884-z

Introduction Carcinoma vulva is a rare gynaecological malignancy accounting for 5%, but is associated with significant surgical complication rate of 40%- 60%. The study introspects different complications encountered following vulval carcinoma surgeries. Methodology This is a retrospective study conducted in the Gynaecologic Oncology Department of a Tertiary Care Hospital in India, where electronic medical records of patients with vulval carcinoma who underwent surgery between 1 January 2016 and 31 October 2021 were reviewed and analysed. Results A total of 33 patients were identified during this period. The mean age was 60.1 (SD 11.7), and the median body mass index was 26.5(range 38). Most (21, 63%) of them belonged to FIGO I (surgical staging for vulval cancer 2009). Radical wide local excision was performed among 23 patients, and 10 underwent radical vulvectomy. Three of them underwent concomitant flap repair with V–Y flaps. Inguinofemoral dissection was performed among thirty patients. Squamous cell carcinoma was the most common histology. Thirteen patients received adjuvant treatment. The average time to adjuvant treatment was seven weeks. There were 16 (48%) observed complications, most commonly wound breakdown—inguinal wound (5, 15%) and vulval wound breakdown (6,18%). The wound breakdowns were managed conservatively with antibiotics and dressing. Lymphocyst aspiration was done among two patients and interventional lymphangio-embolization in one. One vulval wound breakdown underwent flap reconstruction. Conclusion The complication rate was 48% of whom most patients had minor complications (14/16: Clavein–Dindo grade 1 and grade II). The mainstay treatment for vulval carcinoma is surgery combined with inguinofemoral lymph node dissection with or without adjuvant radiation. Lymphadenectomy majorly contributes to post-operative morbidity. Proper selection of patients, multi-disciplinary discussion, and sentinel node mapping can minimize post-operative complications.