Vulvar cancer is a rare disease, and cure rates were low until the mid-20th century. The introduction of an en bloc radical vulvectomy and bilateral groin and pelvic lymph node dissection saw them rise from 15–20% to 60–70%. However, this very radical surgery was associated with high physical and psychological morbidity. Wounds were usually left open to granulate, and the average post-operative hospital stay was about 90 days. Many attempts have been made to decrease morbidity without compromising survival. Modifications that have proven to be successful are as follows: (i) the elimination of routine pelvic node dissection, (ii) the use of separate incisions for groin dissection, (iii) the use of unilateral groin dissection for lateral, unifocal lesions, (iv) and radical local excision with 1 cm surgical margins for unifocal lesions. Sentinel node biopsy with ultrasonic groin surveillance for patients with node-negative disease has been the most recent modification and is advocated for patients whose primary cancer is <4 cm in diameter. Controversy currently exists around the need for 1 cm surgical margins around all primary lesions and on the appropriate ultrasonic surveillance for patients with negative sentinel nodes.
外阴癌是一种罕见疾病，直至20世纪中叶其治愈率仍处于较低水平。随着整块根治性外阴切除术及双侧腹股沟与盆腔淋巴结清扫术的引入，治愈率从15-20%提升至60-70%。然而，这种高侵袭性手术伴随着严重的生理与心理并发症。术后创口通常保持开放以待肉芽组织生长，平均住院时间长达90天左右。学界为降低并发症发生率同时不影响生存率进行了诸多尝试，以下改良方案已被证实具有成效：（一）取消常规盆腔淋巴结清扫；（二）采用独立切口进行腹股沟淋巴结清扫；（三）对侧位单灶性病变实施单侧腹股沟清扫；（四）对单灶性病变实施切缘1厘米的根治性局部切除术。针对淋巴结阴性患者，结合前哨淋巴结活检与腹股沟超声监测已成为最新改良方案，该方案主要适用于原发癌灶直径小于4厘米的患者。当前争议焦点集中于：是否所有原发病灶均需保证1厘米手术切缘，以及前哨淋巴结阴性患者的最佳超声监测方案。
Conservative Management of Vulvar Cancer—Where Should We Draw the Line?
肿瘤(癌症)患者之家