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Risk Factors for Wound Complications in Vulvar Cancer Surgery and Indications for Reconstructive Surgery.

Justin J E Delahaije1,2, Ephrahim E Jerry1, Saskia Houterman3

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Reconstructive surgery (RS) increases wound complications after vulvar cancer surgery, alongside larger tumors and specific locations. Primary closure (PC) may be preferred when feasible for vulvar cancer patients.

Keywords:
reconstructive surgeryrisk factorsvulvar cancerwound complications

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Area of Science:

  • Gynecologic Oncology
  • Surgical Oncology
  • Wound Healing Research

Background:

  • Vulvar cancer surgery frequently results in significant postoperative wound complications.
  • Reconstructive surgery (RS) is typically reserved for extensive vulvar tumors or recurrences.

Purpose of the Study:

  • To identify the incidence and risk factors for wound complications following vulvar cancer surgery.
  • To compare the impact of primary closure (PC) versus reconstructive surgery (RS) on wound complication rates.

Main Methods:

  • Retrospective cohort study across four Dutch gynecologic oncology centers (2018-2022).
  • Analysis of wound complications in patients undergoing PC versus RS.
  • Logistic regression used to identify risk factors, adjusting for confounding variables.

Main Results:

  • A total of 394 women were included (318 PC, 76 RS).
  • The overall incidence of wound complications was 46.7%, with wound breakdown being the most frequent complication (42.4%).
  • Reconstructive surgery (RS) was significantly associated with an increased risk of wound complications (OR 1.2; 95% CI 1.1-1.2) after multivariate analysis, despite other factors like tumor size and location also being identified.

Conclusions:

  • Key risk factors for vulvar cancer surgery wound complications include larger tumor size, proximity to the urethra, urethral resection, and perineal location.
  • Reconstructive surgery (RS) is an independent risk factor for increased wound complications, likely due to patient and tumor selection criteria.