Wide local excision is a type of surgery to cut out a tumor, along with surrounding tissue. People may have wide local excision to remove a vulvar tumor.
A person can have wide local excision to treat early stage vulvar cancer.
Wide local excision is a less extensive procedure than a vulvectomy, as it leaves more of the surrounding tissue intact.
This article looks at what to expect from a wide local excision procedure, recovery, and outlook.
People may have wide local excision to treat vulvar intraepithelial neoplasia (VIN), or small tumors which are no more than 1 millimeter (mm) deep into the tissue.
A wide local excision for vulvar cancer removes a vulvar tumor and around 1–2 centimeters (cm) of surrounding tissue.
A simple vulvectomy is a surgical procedure that removes all of the vulva but leaves most of the tissue underneath in place. People may have a simple vulvectomy to remove VIN that is in multiple areas of the vulva.
If people have a wide local excision that removes
The
Extensive surgery of the vulva may affect a person’s sex life, alter the appearance of the vulva, and affect how the body is able to remove waste through the urethra and anus. All of these factors can negatively affect quality of life. Removing nearby lymph nodes may also result in severe lymphedema in the leg.
For less advanced cancer, it is usually not necessary to remove as much of the healthy surrounding tissue. Wide local excision is a less extensive procedure than a vulvectomy, and for less advanced vulvar cancers, saves more healthy surrounding tissue.
According to the United Kingdom’s National Health Service (NHS), the surgery takes about an hour, and people will usually have a general anesthetic before it takes place.
People will receive a thin tube, or cannula, into the arm or hand to supply intravenous fluids and medication. This is also known as a peripheral IV. People may also have a catheter to drain urine from the bladder.
During a wide local excision, a surgeon will use a scalpel to cut out the tumor. They will also cut out
A doctor may use dissolvable stitches to close the wound. A person may be in surgery and recovery for around 3–4 hours.
It is important to let a healthcare professional know if a person is taking any medications, supplements, herbal remedies, or drugs before surgery. People will also need to let them know if they have any illness or allergies before surgery.
Smoking can increase the risk of complications and delay wound healing, so stopping smoking before the procedure, ideally a week or more beforehand, can help to reduce the risk. Even stopping a day before surgery can help.
Before surgery, people may attend a pre-operative assessment. This ensures people are fit and healthy enough to have surgery.
A doctor will also explain what will happen during surgery. The person will sign a consent form to allow the surgery to take place.
After surgery, doctors will monitor a person in hospital and provide pain medication to relieve any pain.
Recovery time may vary for each individual, but people may be able to leave hospital on the same day or within 3 days of surgery. A person may feel fatigue and weakness for a few days after surgery.
At home, recovery may include:
- resting
- taking pain medication to manage any discomfort
- bathing the area with lukewarm water and then drying at least three times a day or after going to the toilet
- pouring warm water over the wound to help to ease discomfort after urinating
People may be able to return to work 2–6 weeks after surgery, depending on their type of work and the extent of the surgery.
However, recovery times vary depending on how deep the incision was, wound healing, and the person’s overall health.
People will need to contact a doctor if they experience any of the following:
- skin inflammation
- unusual warmth from the surgical site
- foul-smelling or heavy discharge
- bright red bleeding
According to a
Wide local excision may be effective for removing tumors measuring no more than 2 cm in diameter and no more than 1 mm deep into the tissue. For these tumors, people will usually not require groin node dissection. A groin node dissection is a procedure that removes lymph nodes from the groin.
According to the
A relative survival rate helps give an idea of how long a person with a particular condition will live after receiving a diagnosis compared with those without the condition.
For example, if the 5-year relative survival rate is 70%, it means that a person with the condition is 70% as likely to live for 5 years as someone without the condition.
It is important to remember that these figures are estimates. A person can consult a healthcare professional about how their condition is going to affect them.”
The potential risks of wide local excision include:
- bleeding
- infections
- delayed wound healing
- blood clots in the legs or lungs
- injury to nearby structures, such as nerves, blood vessels, urethra, or anal sphincter
- risks in relation to anesthetic
- need for further surgeries or treatments
According to Medicare, the costs for an extensive wide local excision, or simple partial vulvectomy, are as follows:
| Ambulatory surgical center | Hospital outpatient department | |
|---|---|---|
| Total cost | $1,934 | $3,284 |
| Doctor fee | $605 | $605 |
| Medical facility fee | $1,329 | $2,679 |
| Medicare pays | $1,548 | $2,628 |
| Person pays | $386 | $656 |
The above prices derive from national averages in 2022. People may need to pay extra costs for any additional doctors or services. Wide local excision that removes less tissue may have a different cost.
Wide local excision is surgery to cut out a vulvar tumor and is a less extensive procedure to treat vulvar cancer.
For small, early-stage tumors, wide local excision may be an effective treatment, although there is a risk of the cancer recurring.