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Surgery for vulval cancer will remove parts of the vulva and the lymph nodes in the
groins. The extent of surgery is highly individual and will be tailored to the extent
of the cancer. Surgery may include parts of the vagina, outer parts of the urethra
or the skin around the anus. Flaps may be required to close the wound without tension.
Patients with very early vulval cancer with hardly any invasion of the cancer into
the skin will not require a lymph node dissection because the chance of lymph node
involvement is extremely low. Some patients with early vulval cancer limited to
one side of the vulva will only require a groin node dissection on the affected
side. In some patients radiotherapy with or without chemotherapy may be an alternative
to primary surgery.
Before the operation imaging (X-ray and CT scan) and blood tests are routine measures
and give useful information prior to surgery. Usually no bowel prep is required.
Please fast at least 6 hours prior to surgery. Please stop smoking before the operation
as it makes your postoperative management much easier.
The procedure requires general anaesthesia. Some patients prefer to have an epidural
catheter for adequate pain control after the operation.
The procedure is usually takes 2 to 3 hours. The incision on the vulval is highly
individual but the incision for the groin node dissection will almost always be
below and parallel to the inguinal crease.
When you wake up from general anaesthesia there will be some lines running in and
out of you. A drip will give you the necessary fluids, a catheter will drain the
urine from your bladder and the epidural catheter will allow for adequate pain control.
An oxygen mask will supply oxygen to the respiratory system. A drain may collect
body fluid from the groins and/or the vulva. These lines will be removed once I
am happy that your body functions return to normal, which is usually after 24 to
48 hours and the fluid production slows down.
The final histopathological report may take up to one week. It forms the basis for
the decision if any further treatment is required. I will discuss the histopathological
findings with you and sometimes I will recommend postopoerative radiotherapy to
the vulva and/or to the pelvis and the groins. If radiotherapy is required I will
bring you in contact with the radiotherapist.
Surgery always carries risks. Before surgery, I do everything to minimise these risks.
I give antibiotics before I do the incision in order to avoid skin and other infections.
Commencing prior to surgery I give Heparin or calf compression stockings in order
to prevent the formation of blood clots in the legs. At surgery sterile handling
of instruments further reduces the risk of infectious complications. However, there
are some immanent risks of surgery for vulval cancer:
Wound healing: Especially in older patients with diabetes mellitus, in smokers or
in obese patients the risk of wound infection and wound breakdown is significant.
Lymph oedema: Lymphatic fluid usually drains from the legs via the lymph glands into
the groin and from there into pelvis and the aorta back into the blood circulation.
When lymph glands had to be removed, some fluid may accumulate in the legs. The
risk of lymph oedema is around 20% in patients who had to have a lymph node dissection.
Injury to big blood vessels (blood loss need of blood transfusion), nerves, the
urinary bladder, the ureter or bowel.
Deviation of the urinary stream
Infections to the bladder, the abdominal wound, the lungs with resulting temperatures
and septicemia
Thromboembolic complications (formation of blood clots)
Numbness, pain and swelling to the skin around the incision, which will prevent you
from sitting (car, office, home) comfortably.
Psychosexual changes
Surgery to the vulva does not affect the ovaries and the hormonal status. The only
exemption is if radiotherapy is recommended to the pelvis. In this case the ovaries
would certainly become affected. Alternatively, the ovaries could be transposed
surgically to bring them out of the radiation field.
You need to stay in hospital for around one week. I recommend to give yourself a
break for the next few weeks. Especially I recommend to avoid intercourse, vaginal
tampons and full baths for the next 6 weeks.
Please notify me immediately if your condition becomes worse after you have been
discharged from hospital.
After surgery, you should be seen regularly for follow-up for at least 5 years. These
examinations will include PAP smears, pelvic examinations and sometimes imaging
methods.
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