Evolution of surgical treatment of vulvar cancer: a literature review

In the structure of gynecological oncological pathology, vulvar cancer is located after cancer of the body of the uterus, cervix, and ovaries. The first publications on the surgical treatment of vulvar cancer date back to the second half of the 19th century. In the works of surgeons F. J. Taussig (1949) and S. Way (1960), radical vulvectomy with regional lymphadenectomy became a method of treating patients with invasive squamous cell carcinoma of the vulva. With this aggressive approach, sufficiently high levels of five-year survival of patients with vulvar cancer were achieved — up to 90% in a localized process, and up to 50% in the presence of metastases in regional lymph nodes. In the 1980s and 1990s, the transition from ultra-radical operations to economical, sparing ones became possible because of factors such as the introduction of the sentinel lymph node determination method. Ramon M. Cabanas in the 1960s first coined the term sentinel of signal lymph node. Surgical treatment for vulvar cancer has evolved over time, from extended, ultra-radical surgeries to a more individualized, conservative surgical approach, including widespread local excision with sentinel lymph node (SLN) detection instead of extended surgeries for early vulvar cancer. The evolution of the surgical treatment of vulvar cancer over the years is undoubtedly associated with the developments of the surgical technique, understanding of the biology of tumor growth, and radiation medicine along with the possibilities of drug therapy. The transition from simple tumor excision to extended, ultra-radical operations with inguinal-femoral, retroperitoneal, and pelvic lymphadenectomy made it possible to achieve good survival rates for this group of patients. In any case, further research is required to understand the adequate scope of surgical treatment for vulvar cancer.