Exenteration for advanced carcinoma of the vulva

Nine patients with advanced carcinoma of the vulva which required exenterative procedures have been treated by the authors during the past 10 years. Four patients are still alive 45 months or more after treatment, although one has had a local recurrence. Only one operative death occurred; the four late deaths were all due to local recurrences. The rationale for ultraradical surgery is discussed from the standpoint of the growth pattern of the cancer. Consideration is given to the possible origin of these slower growing tumors from granulomatous disease as well as to blockage of metastases because of obstructed lymphatic channels. A one-stage surgical procedure that includes bilateral groin dissection and a generous perineal phase is discussed in full as is the rationale for surgical treatment.