Possibilities of Surgical Treatment of Vulva Cancer in the Context of the COVID-19 Pandemic

Background. At the end of 2019, a new coronavirus infection emerged in the People’s Republic of China. On March 11, 2020, the World Health Organization announced the start of the COVID­19 pandemic. During 2018, 2068 patients with malignant neoplasms of the vulva were identified, with the majority of patients aged 75–79 years. Surgical treatment is currently the main treatment method for vulva cancer (VC) patients. According to most authors, surgical treatment is the only method providing good long­term results. One of the approaches to reducing the volume of surgical treatment in such patients is the selective biopsy of the sentinel lymph node (SLN).

Aim. To apply the method of SLN biopsy in VC patients with the purpose of reducing the amount of surgical treatment and surgical complications, as well as shortening hospital stay in the context of the COVID­19 pandemic.

Materials and methods. This paper presents the results of surgical treatment of 19 patients with malignant neoplasms of the vulva. All the patients were at risk for a complicated course of COVID­19 due to age and concomitant pathologies. In 13 cases, vulvectomy with SLN biopsy was performed. SLN biopsy was performed by radioisotope lymphoscintigraphy.

Results and discussion.A decrease in the duration of hospital stay and the absence of surgical complications characteristic of lymphadenectomies were noted.

Conclusion. Reducing the duration of hospital stay in the context of the COVID­19 pandemic is an urgent task. The method of SLN biopsy in patients with invasive squamous cell carcinoma of the vulva with T1A — T2 was found to be effective, allowing the amount of surgical treatment to be reduced. Vulvectomy accompanied by SLN biopsy is the surgical treatment of choice in the context of strict anti­epidemiological measures in the COVID­19 pandemic.

1. Kannan S., Shaik Syed Ali P., Sheeza A., Hemalatha K. COVID-19 (Novel Coronavirus 2019) — recent trends. Eur Rev Med Pharmacol Sci. 2020;24(4):2006–11. DOI: 10.26355/eurrev_202002_20378

2. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J., et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33. DOI: 10.1056/NEJMoa2001017

3. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. 2020. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41:145–51. DOI: 10.3760/cma.j.issn.0254-6450.2020.02.003

4. Gantsev S.K., Menshikov K.V. Oncological care during the Covid-19 pandemic (literature review). Creative surgery and oncology. 2020;10(3): 233–40 (In Russ.). DOI: 10.24060/2076-3093-202010-3-233-240

5. Kaprin A.D., Gameeva E.V., Roshchin D.O., Kostin A.A., Alekseeva G.S., Khoronenko V.E., et al. Remodeling the cancer service in the context of the COVID-19 pandemic at the Federal research center of the 1st level. Research and Practical Medicine Journal. 2020;7(2):10–21 (In Russ.). DOI: 10.17709/2409-2231-2020-7-2-1

6. Kaprin A.D., Starinsky V.V., Petrova G.V. (eds.) State of cancer care for population in Russia in 2018. Moscow: National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation; 2019 (In Russ.).

7. Temporary guidelines: the prevention, diagnosis and treatment of the new coronavirus infection (COVID-2019). Moscow: Ministry of Health of the Russian Federation; 2020. 236 p. (In Russ.).

8. Menshikov K.V., Sultanbaev A.V., Pushkarev V.A., Menshikova I.A., Lipatov D.O. The extension of vulvar cancer in patients of the Republican Clinical Oncological Dispensary in Ufa. Malignant neoplasms. 2020;10(3s1):88 (In Russ.).

9. Ramirez P.T., Chiva L., Eriksson A.G.Z., Frumovitz M., Fagotti A., Gonzalez Martin A., et al. COVID-19 global pandemic: options for management of gynecologic cancers. Int J Gynecol Cancer. 2020;30(5):561–3. DOI: 10.1136/ijgc-2020-001419

10. Raimond E., Delorme C., Ouldamer L., Carcopino X., Bendifallah S., Touboul C., et al. Surgical treatment of vulvar cancer: impact of tumor-free margin distance on recurrence and survival. A multicentre cohort analysis from the francogyn study group. Eur J Surg Oncol. 2019;45(11):2109–14. DOI: 10.1016/j.ejso.2019.07.005

11. Mukhin A.A., Zharov A.V., Chernova L.F., Gubaidullina T.N., Kravchenko G.R., Saevets V.V., et al. Surgical treatment of patients with cancer of the vulva. Problems in oncology. 2018;64(2):190–5 (In Russ.).

12. Alkatout I., Schubert M., Garbrecht N., Weigel M.T., Jonat W., Mundhenke C., et al. Vulvar cancer: epidemiology, clinical presentation, and management options. Int J Womens Health. 2015;7:305–13. DOI: 10.2147/IJWH.S68979

13. Ghebre R.G., Posthuma R., Vogel R.I., Geller M.A., Carson L.F. Effect of age and comorbidity on the treatment and survival of older patients with vulvar cancer. Gynecol Oncol. 2011;121(3):595–9. DOI: 10.1016/j.ygyno.2011.02.005

14. Garganese G., Tagliaferri L., Fragomeni S.M., Lancellotta V., Colloca G., Corrado G., et al. Personalizing vulvar cancer workflow in COVID-19 era: a proposal from Vul.Can MDT. J Cancer Res Clin Oncol. 2020;146(10):2535–45. DOI: 10.1007/s00432-020-03312-9

15. Alongi P., Laudicella R., Desideri I., Chiaravalloti A., Borghetti P., Quartuccio N., et al. Positron emission tomography with computed tomography imaging (PET/CT) for the radiotherapy planning definition of the biological target volume: PART 1. Crit Rev Oncol Hematol. 2019;140:74–9. DOI: 10.1016/j.critrevonc.2019.01.011

16. Garganese G., Collarino A., Fragomeni S.M., Rufini V., Perotti G., Gentileschi S., et al. Groin sentinel node biopsy and 18F-FDG PET/CTsupported preoperative lymph node assessment in cN0 patients with vulvar cancer currently unfit for minimally invasive inguinal surgery: The GroSNaPET study. Eur J Surg Oncol. 2017;43(9):1776–83. DOI: 10.1016/j.ejso.2017.06.018