Background: Patients with advanced vulvoperineal cancer require a multidisciplinary treatment approach to ensure oncological safety, timely recovery, and the highest possible quality of life (QoL). Reconstructions in this region often lead to complications, affecting approximately 30% of patients. Flap design has evolved towards perforator-based approaches to reduce functional deficits and (donor site) complications, since they allow for the preservation of relevant anatomical structures. Next to their greater surgical challenge in elevation, their superiority over non-perforator-based approaches is still debated. Methods: To compare outcomes between perforator and non-perforator flaps in female vulvoperineal reconstruction, we conducted a systematic review of English-language studies published after 1980, including randomized controlled trials, cohort studies, and case series. Data on demographics and surgical outcomes were extracted and classified using the Clavien–Dindo classification. We used a random-effects meta-analysis to derive a pooled estimate of complication frequency (%) in patients who received at least one perforator flap and in patients who received non-perforator flaps. Results: Among 2576 screened studies, 49 met our inclusion criteria, encompassing 1840 patients. The overall short-term surgical complication rate was comparable in patients receiving a perforator (n= 276) or a non-perforator flap (n= 1564) reconstruction (p* > 0.05). There was a tendency towards fewer complications when using perforator flaps. The assessment of patients’ QoL was scarce. Conclusions: Vulvoperineal reconstruction using perforator flaps shows promising results compared with non-perforator flaps. There is a need for the assessment of its long-term outcomes and for a systematic evaluation of patient QoL to further demonstrate its benefit for affected patients.
背景：晚期外阴会阴癌患者需要多学科综合治疗，以确保肿瘤学安全性、促进及时康复并尽可能提高生活质量。该区域的重建手术常导致并发症，影响约30%的患者。为减少功能缺损和（供区）并发症，皮瓣设计已向基于穿支血管的方向发展，因其能够保留相关解剖结构。尽管穿支皮瓣在切取技术上更具挑战性，但其相对于非穿支皮瓣的优越性仍存争议。方法：为比较穿支与非穿支皮瓣在女性外阴会阴重建中的效果，我们对1980年后发表的英文研究进行了系统综述，包括随机对照试验、队列研究和病例系列。提取人口统计学和手术结果数据，并采用Clavien-Dindo分级系统进行分类。通过随机效应荟萃分析，分别汇总接受至少一种穿支皮瓣与非穿支皮瓣患者的并发症发生率（%）。结果：在2576项筛选研究中，49项符合纳入标准，共涵盖1840例患者。接受穿支皮瓣（n=276）与非穿支皮瓣（n=1564）重建患者的总体短期手术并发症发生率相当（p* > 0.05），但穿支皮瓣有降低并发症的趋势。患者生活质量的评估数据较为缺乏。结论：与非穿支皮瓣相比，穿支皮瓣在外阴会阴重建中展现出良好前景。未来需对其长期结果进行评估，并对患者生活质量进行系统评价，以进一步证实其对患者的获益。
肿瘤(癌症)患者之家