Introduction: Vulvar carcinomas comprise almost 5% of all malignant tumors of the female genital tract. The final diagnosis is made after histologic examination of biopsy specimens obtained from different sites in the vulva. Primary therapeutic approach in all cases is surgery, whereas the operative procedure depends on the size and location of the lesion, stage of the disease, general condition and age of the patient, as well as on the condition of the surrounding tissue and possible continuance of sexual life.
Methods: In the period from 1985-1999, there were 39 patients with invasive forms of vulvar carcinomas operated at the Department of Gynaecology in Novi Sad. Radical vulvectomy associated with inguinal-femoral lymphadenectomy was performed in 26 (66.6%) patients. During 1994, a wide "butterfly-shaped "block" dissection of the vulva, pubis and inguinal area was done, whereas during the following period, the operative area was reduced by application of separate inguinal incisions after Hacker, leaving the tissue bridge in between.
Results: The mean age of operated patients was 62.1 years (34-85). There were 53.8% stage I, 17.9% stage II, 20.7% stage III and 7.6% stage IV patients. In patients undergoing radical surgery the average number of extirpated lymph nodes was 16.3 out of which in 7 (26.9%) cases the nodes were positive. Lethal outcome was recorded in 4 (15.3%) patients. Two (7.6%) died of pulmonary thromboembolism and 2 (7.6%) during the following 5 years for diffuse dissemination of metastases. During 1994, complications were recorded in 69.2% operated patients versus 7.6% recorded during the following period.
Conclusions: Radical vulvectomy associated with bilateral inguinal-femoral lymphadenectomy is a standard procedure in surgical treatment of invasive stages of vulvar carcinoma protruding more than 1 mm. The application of two separate inguinal incisions after Hacker resulted in shortening the intrahospital postoperative period from 34.2 to 14 days and reduction of the rate of wound dehiscence and postoperative complications in the period following 1994.