Radical Vulvectomy with Rectus Abdominis Flap Reconstruction for Recurrent Vulvar Cancer Post-Radiotherapy: Clinical Efficacy and Functional Outcomes

ObjectiveRecurrent vulvar cancer after radiotherapy is a devastating condition that severely impairs patients quality of life. Although radical vulvectomy can improve survival and quality of life in primary cases, patients with post-radiation recurrence are at high risk for severe wound-related complications. To address this challenge, our team adopted a combined approach of radical vulvectomy and rectus abdominis flap reconstruction, which has yielded favorable therapeutic outcomes. MethodsThis retrospective study enrolled patients with radiotherapy-recurrent vulvar cancer who underwent radical vulvectomy combined with rectus abdominis flap reconstruction between 2023 and 2024. The primary endpoint was the change in quality of life, assessed using the EORTC QLQ-C30 and QLQ-VU34 questionnaires. ResultsEleven patients underwent radical vulvectomy with rectus abdominis flap reconstruction. The median patient age was 67 years, and the median BMI was 28.98. The median operative time and intraoperative blood loss were 210 minutes and 400 mL, respectively. All patients achieved R0 resection. Nine patients experienced only minor complications (Clavien - Dindo grade II), while two patients developed complications requiring intervention under local anesthesia (grade IIIa). No wound infections, wound dehiscence, or donor-site complications were observed. Postoperatively, a significant improvement in quality of life was evident across all patients, particularly in the domains of physical functioning, pain reduction, and overall global health status (all P < 0.05). ConclusionsRadical vulvectomy combined with rectus abdominis flap reconstruction significantly improves quality of life and oncological outcomes in patients with radiotherapy-recurrent vulvar cancer. This combined approach represents a valuable and safe treatment option that merits broader clinical implementation, preferably within a multidisciplinary team setting.