Oncological outcomes, surgical margins, and adjuvant treatment delays in vulvar cancer patients with or without reconstruction during primary surgery

Objective: As vulvar reconstruction has been proposed to improve surgical margins and could affect the timing of adjuvant therapy in patients with vulvar cancer, we aimed to compare oncological outcomes, surgical margins, and adjuvant treatment delays of patients with or without a vulvar reconstruction in their primary vulvar cancer surgery. Methods: We conducted a retrospective, single-center study comprising patients who underwent surgery due to primary vulvar squamous cell carcinoma in Tampere University Hospital, Finland, in 2005-2018. The primary outcome was the number of vulvar recurrences. Secondary outcomes were time to vulvar recurrence, disease-free and overall survival, surgical margins, and adjuvant treatment delays. Results: Overall, 126 patients were included (reconstruction n = 37, direct closure n = 89). Median follow-up time was 46.0 (interquartile range [IQR] 15.5-102.0) vs 55.0 months (IQR 17.0-102.0) in the reconstruction and direct closure groups, respectively. Vulvar recurrences occurred in 18.9% vs 20.2% of patients, respectively (p = 0.87). Time to vulvar recurrence, disease-free survival, or overall survival were comparable between the groups despite an overrepresentation of large [40.0 mm (IQR 25.5-55.0) vs 20.0 mm (IQR 13.0-35.0), p < 0.001], medial (81.1% vs 56.2%, p = .008), multifocal (29.7% vs 7.9%, p = .001), deeply invasive tumors [8.0 mm (IQR; 4.5-14.5) vs 3.5 mm (IQR 2.0-8.0), p < .001] presenting with perineural (32.3% vs 13.6%, p = .035) and lymphovascular space invasion (42.9% vs 15.6%, p = .003) in the reconstruction group. Surgical margins did not differ between the groups despite differences in pathological characteristics. Adjuvant therapy was not delayed in the reconstruction group compared to direct closure group [median delay 59.0 (IQR 52.0-73.8) vs 61.0 days (IQR 50.0-66.0), p = .59], and there was no statistically significant difference in the need for adjuvant therapy. Conclusions: Vulvar reconstruction was associated with non-inferior oncological outcomes compared to the direct closure group, though this conclusion is limited by the retrospective nature of the study. Frequent co-operation between gynecologic oncologists and plastic surgeons is encouraged.