Changing surgical approaches to vulvar cancer

Interest in reducing surgical morbidity and maintaining sexual function continues to stimulate the development of tissue-conserving vulvar operations for patients with resectable vulvar cancers. A growing body of clinical experience has demonstrated the safety of this approach, but further refinements of technique and patient eligibility criteria are likely. Tissue-flap reconstruction of the vulva has expanded the surgeon's ability to radically resect large cancers with less morbidity and functional impairment. The range of available techniques allows a more versatile surgical approach that can be individualized to lesion size and location. The risk of local recurrence is strongly related to the adequacy of resection margins. Radical resection of recurrent vulvar disease can salvage significant numbers of node-negative patients.