Optimal version of I and II stages vulvar carcinoma--surgical treatment

In gynaecological clinic years during 1970-1986, 270 vulval carcinoma patients (I stage 12.6%; II 50.3%; III 29.3%; IV 7.8%) underwent treatment. 34.8% patients age was 60-69, 32.2% 70-79. Average age 66 years. In 70% patients diagnostic epidermoidal, 22.2% low differentiated cancer and 1 case (0.4%) adenocarcinoma. 187 patients underwent total vulvectomy (additional telecurie therapy 18 patients, 2 chemotherapy), 54 total vulvectomy + regional lymphadenectomy, 29 chemo (6), radio (3), symptomatic (20) therapy. 5-year recovery generally equated 40.1% (vulvectomy + lymphadenectomy 58.4%; vulvectomy only 35.8%), at I-II stage 52.1% (vulvectomy + lymphadenectomy 85.7%; vulvectomy 50.0%), at III stage 11.4% (vulvectomy + lymphadenectomy 42.9%; vulvectomy 6.7%), at IV stage 0%. T1 regional lymph nodes involvement, clinical signs (N1, N2, N3) were present in 24.1% patients, T2 36.1%, T3 70.8%. Out of marked 92 patients, lymphadenectomy was performed in 54, mainly with T1 and T2. Histological metastases observed in 48.1%, i.e. no more than 14% T1 and T2 patients. Considering the above raised question rised - it is justifiable in I and II stage patients with negative lymph nodes, regarding advanced age and concomitant diseases, perform protracted traumatic operation. But without histology it's hard to decide lymph nodes condition. Taking into account certain stage characteristic of metastatic spreading, in our clinic from 1985 in T1 and T2 vulval carcinoma without (N0) and/or with (N1, N2) regional lymph nodes involvement signs modified less traumatic one stage extensive vulvectomy with bilateral inguinal lymphadenectomy is performed. Suboperational morphological (cytology, histology) lymph nodes study is conducted. Upon metastases discovery dissection is carried out on femoral lymph nodes as wall.(ABSTRACT TRUNCATED AT 250 WORDS)