Enhancing outcomes in vulvar cancer surgery: A comprehensive approach to complication prevention

Abstract

Objective

This study aimed to identify and synthesize strategies that reduce surgical complications in vulvar cancer, focusing on preoperative, intraoperative, and postoperative measures.

Study Design

A literature review was conducted by searching PubMed, Scopus, and ScienceDirect databases. Studies from 2000 to 2024 published in English and Spanish language were included. Articles were included if they addressed preoperative assessment, surgical approaches, lymph node management, wound care, or psychosocial support in vulvar cancer patients.

Results

Conservative surgical techniques—particularly the triple-incision approach and sentinel lymph node biopsy (SLNB)—demonstrate lower morbidity while maintaining acceptable oncologic control, especially in early-stage disease. Video endoscopic inguinal lymphadenectomy has shown promise in further reducing wound complications, although its adoption is limited to specialized centers with technical expertise. Optimizing patients preoperatively through glycemic control, nutritional support, and smoking cessation can decrease the risk of wound infection and dehiscence. Postoperative interventions such as meticulous wound care, negative-pressure wound therapy, and early lymphatic drainage techniques help prevent chronic lymphedema. Additionally, psychosocial and sexual counseling emerges as crucial for addressing the significant emotional and functional challenges associated with vulvar surgery.

Conclusions

A multidisciplinary, patient-centered approach is essential to mitigate the high morbidity traditionally linked to vulvar cancer surgery. Ongoing research into advanced surgical methods, standardized perioperative protocols, and holistic patient support will be key to further improving outcomes, preserving quality of life, and reducing the burden of long-term complications in this rare but challenging malignancy.