Pelvic Exenteration for the Treatment of Locally Advanced Vulvar Cancer in South West Wales

SIMPLE SUMMARY: There is no consensus on the optimal treatment strategy for locally advanced vulvar cancer. In this paper, we aimed to highlight the outcomes from pelvic exenteration in our centre. Here, we not only demonstrated the role of pelvic exenteration in the treatment of locally advanced vulvar cancer, but we also revealed modifiable and non-modifiable factors that contribute to outcomes. Furthermore, we highlighted that tumours that are less than 40 mm diameter do not usually require flap reconstruction while tumours of 40 mm diameter or greater would often require flap reconstruction—a finding that we believe has not been previously reported in the literature. However, we recognise that research must continue into treatment options that limit the radicality of surgical resection, although such alternative approaches must offer comparable survival advantages. ABSTRACT: The treatment of locally advanced vulvar carcinoma (LAVC) represents a major challenge. We investigated the role of pelvic exenteration as a treatment of LAVC. Women who underwent pelvic exenteration for primary and recurrent LAVC in our centre between 2001 and 2019 were included. Among the 19 women included during the study period, 14 women (73.7%) had primary LAVC while 5 women (26.3%) had recurrent disease. Surgical resection margins were microscopically clear (R0) in 94.7% of patients—14/14 undergoing primary treatment and 4/5 undergoing treatment for recurrent disease. Complete closure of the wound was achieved in 100% of women, with no wound left to heal by secondary intention. Tumour size was a predictor of requiring myocutaneous flap reconstruction, with all tumours less than 40 mm undergoing primary closure, while almost all tumours 40 mm diameter or greater (14/15 women) required flap reconstruction (p = 0.001). The 30-day major morbidity rate was 42% and there was no perioperative death. The mean overall survival was 144.8 months (2–206 months), with 1-, 2- and 5-year survival rates of 89.5%, 75.1% and 66.7%, respectively. In our centre, a primary surgical approach to the management of LAVC has resulted in good survival outcomes with acceptable morbidity rates.