Surgical interventions for early squamous cell carcinoma of the vulva (Cochrane Review)

A substantive amendment to this systematic review was last made on 26 August 1999. Cochrane reviews are regularly checked and updated if necessary.

Background: Radical surgery has been standard treatment for patients with early vulvar cancer since the mid 20th 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 criteria set by the Cochrane Gynaecological Cancer Group were used. We searched MEDLINE and EMBASE (last search on 15th August 2001), and our own publication archives, based on a prospective handsearch of six leading relevant journals begun in December 1986. Reference lists of identified studies, gynaecological cancer handbooks and conference abstracts were also used.

Selection criteria: Randomized controlled trials (RCTs), case controled and observational studies on the effectiveness of surgical treatment (local surgical treatment as well as regional lymph node dissection) of patients with cT1N0M0 squamous cell carcinoma of the vulva. Outcome measures were overall, disease specific and disease free survival, treatment complications, quality of life.

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 met the minimum criteria as set by the Cochrane Collaboration and were included in the review. Both were observational studies. From these studies, our conclusions were: 1. Radical local excision is as safe as a radical vulvectomy; 2. Ipsilateral lymph node dissection is safe for patients with a well-lateralised tumour; 3. 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.

Reviewers' conclusions: Available evidence regarding surgical treatment of early vulvar cancer is generally poor. From the evidence with sufficient quality we concluded that radical local excision, ipsilateral lymph node dissection in lateral tumors and triple incision

Citation: Ansink A, van der Velden J.. Surgical interventions for early squamous cell carcinoma of the vulva (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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