Pelvic exenteration for vulvar cancer: contemporary outcomes from a multinational cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Women with vulvar cancer are considerably older than those with other gynaecological malignancies, raising concerns about the tolerability of radical surgery. Yet, for locally advanced or recurrent disease, pelvic exenteration may be the only curative option. Robust evidence to guide decision-making in this population is lacking. MATERIAL AND METHODS: This multicentre observational cohort study used data from the COREPEX registry including women who underwent anterior or total pelvic exenteration between 2005 and 2023 across 20 European tertiary referral centres. The primary outcome was overall survival (OS); secondary outcomes were progression-free survival (PFS) and major postoperative complications. Associations were assessed using multivariable Cox and binomial regression models adjusted for relevant covariates. RESULTS: Among 861 women, 79 (9.2%) had vulvar cancer. Median follow-up was 49 months for OS and 40 months for PFS. Women with vulvar cancer were older and more often overweight. Five-year OS was 32% (95% CI, 19-46) in vulvar cancer versus 29% (95% CI, 25-34) in other cancers, adjusted HR 1.05 (95% CI, 0.75-1.46). Five-year PFS was 34% versus 29%, adjusted HR 0.96 (95% CI, 0.69-1.34). Major complications occurred in 33% vs 29%, adjusted RR 1.12 (95% CI, 0.77-1.58). Lymph node metastases, positive margins, and recurrent or persistent disease independently predicted poorer survival. CONCLUSION: Despite their older age, women with vulvar cancer had survival and morbidity comparable to those with other gynaecological malignancies. These findings support pelvic exenteration as a curative option for selected women with vulvar cancer when complete resection is feasible.
Authors: Diana Zach, Denis Querleu, Mahmood ul Hassan, Matteo Loverro, Giulio Ricotta, Mihai Emil Cãpîlna, Santiago Domingo, David Cibula, Zoltan Novák, Andrea Miranda, Enrique Chacon, Ignacio Zapardiel, Valentyn Svintsitskyi, Olga Matylevich, Gabrielle H. van Ramshorst, Cagatay Taskiran, Fuat Demirkıran, Giuseppe Vizzielli, Francesco Fanfani, Giorgia Garganese, Anna Fagotti, Alejandra Martinez, Elodie Gauroy, Giuseppe Cucinella, Mustafa Zelal Muallem, Nicolò Bizzarri, Sahar Salehi
Institutions: Karolinska University Hospital, Karolinska Institutet, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, Institut universitaire du cancer de Toulouse Oncopole, Universitatea de Medicină, Farmacie, Științe și Tehnologie „George Emil Palade” din Târgu Mureș, Universitat de València, Hospital Universitari i Politècnic La Fe, Charles University, General University Hospital in Prague, National Institute of Oncology, Stiftung Charité, Charité - Universitätsmedizin Berlin, Clinica Universidad de Navarra, Hospital Universitario La Paz, National Cancer Institute, N.N. Alexandrov National Cancer Centre, Ghent University Hospital, Ghent University, Koç University, Amerikan Hastanesi, Istanbul University-Cerrahpaşa, Istanbul University, University of Udine, Ospedale Santa Maria della Misericordia di Udine, Azienda sanitaria universitaria Friuli Centrale, Inserm, Centre de Recherches en Cancérologie de Toulouse, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale"
Language: English
Topic: Genital Health and Disease
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,810
OpenAlex ID: W7130516371