Tumors of female reproductive systemTumors of female reproductive systemОпухоли женской репродуктивной системы1994-40981999-8627Publishing House ABV Press60810.17650/1994-4098-2018-14-3-64-70GYNECOLOGY. ORIGINAL REPORTSГИНЕКОЛОГИЯ. ОРИГИНАЛЬНЫЕ СТАТЬИMinimal vulvar cancer: a literature review and own observationsМинимальный рак вульвы: обзор литературы и собственные клинические наблюденияIl’inA. A.ИльинА. А.
Russian Federation

68A Leningradskaya St., Pesochny Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, Ленинградская ул., 68А

ilin.doc@gmail.comKhadzhimbaA. S.ХаджимбаА. С.
Russian Federation

68A Leningradskaya St., Pesochny Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, Ленинградская ул., 68А

MaksimovS. Ya.МаксимовС. Я.
Russian Federation

68A Leningradskaya St., Pesochny Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, Ленинградская ул., 68А

SobolevI. V.СоболевИ. В.
Russian Federation

68A Leningradskaya St., Pesochny Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, Ленинградская ул., 68А

VyshinskayaE. A.ВышинскаяЕ. А.
Russian Federation

68A Leningradskaya St., Pesochny Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, Ленинградская ул., 68А

KaitovaS. Kh.КаитоваС. Х.
Russian Federation

68A Leningradskaya St., Pesochny Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, Ленинградская ул., 68А

Saint Petersburg Clinical Research Center for Specialized Medical Care (Oncology), Ministry of Health of RussiaГБУЗ «Санкт-Петербургский клинический научно-практический центр специализированных видов медицинской помощи (онкологический)»1610201814364701610201816102018https://ojrs.abvpress.ru/ojrs/article/view/608

Organ-sparing surgeries for vulvar cancer (VC) include wide excision of perineal tissues or hemivulvectomy. The advances in the treatment of VC reduce the risk of complications in patients with somatic pathology and preserve reproductive function in young patients with minimal risk of disease recurrence. The development of new approaches to VC therapy based on currently accepted clinical and morphological criteria will help to improve treatment outcomes. Materials and methods. We retrospectively analyzed the data on 252 patients with VC. Of them, 58 participants had stage I VC, 103 had stage II VC, 79 had stage III VC, and 12 had stage IV VC. The majority of patients (n = 152) underwent vulvectomy; 100 patients underwent extended vulvectomy. Results. Tumor size and depth of invasion are independent prognostic factors determining overall patient survival. The overall survival rate in patients with tumors of 1.5 cm or smaller was 91.7 %, whereas in patients with tumors >2 cm the overall survival rate was 62.2 %. Thefive-year survival rate was 53.9 % in individuals with tumor invasion >1 cm and 84.6 % in individuals with tumor invasion <0.5 cm. Conclusion. We have developed the criteria for minimal vulvar cancer: tumors <2 cm, tumor invasion <5 mm, tumors located outside theclitoris, no tumor emboli in the vessels, no multifocal growth.

К органосохраняющим операциям при раке вульвы (РВ) можно отнести широкое иссечение тканей промежности, или гемивульвэктомию. Дальнейшее совершенствование технологии лечения РВ позволяет снизить осложнения у соматически отягощенных больных и сохранить репродуктивную функцию у больных молодого возраста при минимальном риске рецидива заболевания. Это возможно при условии разработки новых научно обоснованных подходов, опирающихся на современные клинико-морфологические критерии. Материалы и методы. Мы проанализировали диагностику и лечение у 252 больных РВ. Распределение по стадиям было следующим: I стадия РВ – 58 пациенток, II – 103, III – 79, IV – 12. Большинство больных (n = 152) получили хирургическое лечение в объеме вульвэктомии, а 100 пациенткам выполнена расширенная вульвэктомия. Результаты. Независимыми факторами прогноза, определяющими общую выживаемость, являлись размеры и степень инвазии опухоли. У пациенток с опухолью до 1,5 см общая выживаемость составила 91,7 %, при размере опухоли >2 см – 62,2 %. При инвазии опухоли >1 см 5-летняя выживаемость составила 53,9 %, а при инвазии <0,5 см – 84,6 %. Выводы. Сформулированы критерии минимального РВ: размер опухоли до 2 см, инвазия до 5 мм, локализация опухоли вне клитора, отсутствие опухолевых эмболов в сосудах, отсутствие мультифокальных очагов роста.

vulvar cancerminimal vulvar cancervulvectomyрак вульвыминимальный рак вульвывульвэктомия1. Hacker N.F., Berek J.S., Lagasse L.D. et al. Individualization of treatment for stage I squamous cell vulvar carcinoma. Obstet Gynecol 1984;63(2):155–62. PMID: 6694808.Hacker N.F., Berek J.S., Lagasse L.D. et al. Individualization of treatment for stage I squamous cell vulvar carcinoma. Obstet Gynecol 1984;63(2):155–62. PMID: 6694808.2. Homesley H.D., Bundy B.N., Sedlis A. et al. Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (A Gynecologic Oncology Group Study). Am J Obstet Gynecol 1991;164(4):997–1004. PMID: 2014852.Homesley H.D., Bundy B.N., Sedlis A. et al. Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (A Gynecologic Oncology Group Study). Am J Obstet Gynecol 1991;164(4):997–1004. PMID: 2014852.3. Origoni M., Sideri M., Garsia S. et al. Prognostic value of pathological patterns of lymph node positivity in squamous cell carcinoma of the vulva Stage III and IVA FIGO. Gynecol Oncol 1992;45(3):313–6. PMID: 1612509.Origoni M., Sideri M., Garsia S. et al. Prognostic value of pathological patterns of lymph node positivity in squamous cell carcinoma of the vulva Stage III and IVA FIGO. Gynecol Oncol 1992;45(3):313–6. PMID: 1612509.4. Paladini D., Cross P., Lopes A., Monaghan J.M. Prognostic significance of lymph node variables in squamous cell carcinoma of the vulva. Cancer 1994;74(9):2491–6. PMID: 7923005.Paladini D., Cross P., Lopes A., Monaghan J.M. Prognostic significance of lymph node variables in squamous cell carcinoma of the vulva. Cancer 1994;74(9):2491–6. PMID: 7923005.5. Wharton J.T., Gallager S., Rutledge F.N. Microinvasive carcinoma of the vulva. Am J Obstet Gynecol 1974;118(2):159–62. PMID: 4809402.Wharton J.T., Gallager S., Rutledge F.N. Microinvasive carcinoma of the vulva. Am J Obstet Gynecol 1974;118(2):159–62. PMID: 4809402.6. Stehman F.B., Bundy B.N., Dvoretsky P.M., Creasman W.T. Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstet Gynecol 1992;79(4):490–7. PMID: 1553164.Stehman F.B., Bundy B.N., Dvoretsky P.M., Creasman W.T. Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstet Gynecol 1992;79(4):490–7. PMID: 1553164.7. Van Der Velden J., Kooyman C.D., Van Lindert A.C., Heintz A.P. A stage Ia vulvar carcinoma with an inguinal lymph node recurrence after local excision. A case report and literature review. Int J Gynecol Cancer 1992;2(3):157–9. PMID: 11576252.Van Der Velden J., Kooyman C.D., Van Lindert A.C., Heintz A.P. A stage Ia vulvar carcinoma with an inguinal lymph node recurrence after local excision. A case report and literature review. Int J Gynecol Cancer 1992;2(3):157–9. PMID: 11576252.8. Sidor J., Diallo-Danebrock R., Eltze E., Lellé R.J. Challenging the concept of microinvasive carcinoma of the vulva: report of a case with regional lymph node recurrence and review of the literature. BMC Cancer 2006;6:1–5. PMID: 16774683. DOI: 10.1186/1471-2407-6-157.Sidor J., Diallo-Danebrock R., Eltze E., Lellé R.J. Challenging the concept of microinvasive carcinoma of the vulva: report of a case with regional lymph node recurrence and review of the literature. BMC Cancer 2006;6:1–5. PMID: 16774683. DOI: 10.1186/1471-2407-6-157.9. Volgger B., Marth C., Zeimet A. et al. Fulminant course of a microinvasive vulvar carcinoma in an immunosuppressed woman. Gynecol Oncol 1997;65(1):177–9. PMID: 9103410. DOI: 10.1006/gyno.1997.4632.Volgger B., Marth C., Zeimet A. et al. Fulminant course of a microinvasive vulvar carcinoma in an immunosuppressed woman. Gynecol Oncol 1997;65(1):177–9. PMID: 9103410. DOI: 10.1006/gyno.1997.4632.10. Thangavelu A., Andrew A., Buxton E.J. Groin recurrence following Stage 1A squamous cell carcinoma of the vulva. Gynecol Oncol 2006;101(1):172–4. PMID: 16274738. DOI: 10.1016/j.ygyno.2005.09.057.Thangavelu A., Andrew A., Buxton E.J. Groin recurrence following Stage 1A squamous cell carcinoma of the vulva. Gynecol Oncol 2006;101(1):172–4. PMID: 16274738. DOI: 10.1016/j.ygyno.2005.09.057.11. Atamdede F., Hoogerland D. Regional lymph node recurrence following local excision for microinvasive vulvar carcinoma. Gynecol Oncol 1989;34(1):125–8. PMID: 2737520.Atamdede F., Hoogerland D. Regional lymph node recurrence following local excision for microinvasive vulvar carcinoma. Gynecol Oncol 1989;34(1):125–8. PMID: 2737520.12. Hicks M.L., Hempling R.E., Piver M.S. Vulvar carcinoma with 0.5 mm of invasion and associated inguinal lymph node metastasis. J Surg Oncol 1993;54(4):271–3. PMID: 8255090.Hicks M.L., Hempling R.E., Piver M.S. Vulvar carcinoma with 0.5 mm of invasion and associated inguinal lymph node metastasis. J Surg Oncol 1993;54(4):271–3. PMID: 8255090.13. Stehman F.B., Look K.Y. Carcinoma of the vulva. Obstet Gynecol 2006;107(3):719–33. PMID: 16507947. DOI: 10.1097/01. AOG.0000202404.55215.72.Stehman F.B., Look K.Y. Carcinoma of the vulva. Obstet Gynecol 2006;107(3):719–33. PMID: 16507947. DOI: 10.1097/01. AOG.0000202404.55215.72.14. Burke T.W., Levenback C., Coleman R.L. et al. Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol 1995;57(2):215–20. PMID: 7729737. DOI: 10.1006/gyno.1995.1128.Burke T.W., Levenback C., Coleman R.L. et al. Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol 1995;57(2):215–20. PMID: 7729737. DOI: 10.1006/gyno.1995.1128.15. Rouzier R., Haddad B., Atallah D. et al. Surgery for vulvar cancer. Clin Obstet Gynecol 2005;48(4):869–78. PMID: 16286833.Rouzier R., Haddad B., Atallah D. et al. Surgery for vulvar cancer. Clin Obstet Gynecol 2005;48(4):869–78. PMID: 16286833.16. Magrina J.F., Gonzalez-Bosquet J., Weaver A.L. et al. Squamous cell carcinoma of the vulva stage IA: long-term results. Gynecol Oncol 2000;76(1):24–7. PMID: 10620436. DOI: 10.1006/gyno.1999.5638.Magrina J.F., Gonzalez-Bosquet J., Weaver A.L. et al. Squamous cell carcinoma of the vulva stage IA: long-term results. Gynecol Oncol 2000;76(1):24–7. PMID: 10620436. DOI: 10.1006/gyno.1999.5638.17. Yoder B.J., Rufforny I., Massoll N.A., Wilkinson E.J. Stage IA vulvar squamous cell carcinoma: an analysis of tumor invasive characteristics and risk. Am J Surg Pathol 2008;32(5):765–72. PMID: 18379417. DOI: 10.1097/PAS.0b013e318159a2cb.Yoder B.J., Rufforny I., Massoll N.A., Wilkinson E.J. Stage IA vulvar squamous cell carcinoma: an analysis of tumor invasive characteristics and risk. Am J Surg Pathol 2008;32(5):765–72. PMID: 18379417. DOI: 10.1097/PAS.0b013e318159a2cb.18. Wilkinson E.J. Superficial invasive carcinoma of the vulva. Clin Obstet Gynecol 1985;28(1):188–95. PMID: 3987129.Wilkinson E.J. Superficial invasive carcinoma of the vulva. Clin Obstet Gynecol 1985;28(1):188–95. PMID: 3987129.19. Hacker N.F., Van der Velden J. Conservative management of early vulvar cancer. Cancer 1993;71(4 Suppl):1673–7. PMID: 8431905.Hacker N.F., Van der Velden J. Conservative management of early vulvar cancer. Cancer 1993;71(4 Suppl):1673–7. PMID: 8431905.20. Berman M.L., Soper J.T., Creasman W.T. et al. Conservative surgical management of superficially invasive stage I vulvar carcinoma. Gynecol Oncol 1989;35(3): 352–7. PMID: 2599471.Berman M.L., Soper J.T., Creasman W.T. et al. Conservative surgical management of superficially invasive stage I vulvar carcinoma. Gynecol Oncol 1989;35(3): 352–7. PMID: 2599471.21. Farias-Eisner R., Cirisano F.D., Grouse D. et al. Conservative and individualized surgery for early squamous carcinoma of the vulva: the treatment of choice for stage I and II (T1–2N0–1M0) disease. Gynecol Oncol 1994;53(1):55–8. PMID: 8175023. DOI: 10.1006/gyno.1994.1087.Farias-Eisner R., Cirisano F.D., Grouse D. et al. Conservative and individualized surgery for early squamous carcinoma of the vulva: the treatment of choice for stage I and II (T1–2N0–1M0) disease. Gynecol Oncol 1994;53(1):55–8. PMID: 8175023. DOI: 10.1006/gyno.1994.1087.22. Balat O., Edwards C., Delclos L. Complications following combined surgery (radical vulvectomy versus wide local excision) and radiotherapy for the treatment of carcinoma of the vulva report of 73 patients. Eur J Gynaecol Oncol 2000;21(5):501–3. PMID: 11198043.Balat O., Edwards C., Delclos L. Complications following combined surgery (radical vulvectomy versus wide local excision) and radiotherapy for the treatment of carcinoma of the vulva report of 73 patients. Eur J Gynaecol Oncol 2000;21(5):501–3. PMID: 11198043.23. De Hullu J.A., Hollema H., Lolkema S. et al. Vulvar carcinoma: the price of less radical surgery. Cancer 2002;95(11):2331–8. PMID: 12436439. DOI: 10.1002/cncr.10969.De Hullu J.A., Hollema H., Lolkema S. et al. Vulvar carcinoma: the price of less radical surgery. Cancer 2002;95(11):2331–8. PMID: 12436439. DOI: 10.1002/cncr.10969.24. Rutledge F.N., Mitchell M.F., Munsell M.F. et al. Prognostic indicators for invasive carcinoma of the vulva. Gynecol Oncol 1991;42(3):239–44. PMID: 1955186.Rutledge F.N., Mitchell M.F., Munsell M.F. et al. Prognostic indicators for invasive carcinoma of the vulva. Gynecol Oncol 1991;42(3):239–44. PMID: 1955186.25. DeSimone C.P., Van Ness J.S., Cooper A.L. et al. The treatment of lateral T1 and squamous cell carcinomas of the vulva confined to the labium majus or minus. Gynecol Oncol 2007;104(2):390–5. PMID: 17027067. DOI: 10.1016/j.ygyno.2006.08.035.DeSimone C.P., Van Ness J.S., Cooper A.L. et al. The treatment of lateral T1 and squamous cell carcinomas of the vulva confined to the labium majus or minus. Gynecol Oncol 2007;104(2):390–5. PMID: 17027067. DOI: 10.1016/j.ygyno.2006.08.035.26. Tantipalakorn C., Robertson G., Marsden D.E. et al. Outcome and patterns of recurrence for International Federation of Gynecology and Obstetrics (FIGO) stages I and II squamous cell vulvar cancer. Obstet Gynecol 2009;113(4):895–901. PMID: 19305336. DOI: 10.1097/AOG.0b013e31819b413f.Tantipalakorn C., Robertson G., Marsden D.E. et al. Outcome and patterns of recurrence for International Federation of Gynecology and Obstetrics (FIGO) stages I and II squamous cell vulvar cancer. Obstet Gynecol 2009;113(4):895–901. PMID: 19305336. DOI: 10.1097/AOG.0b013e31819b413f.