Venous thromboembolism (VTE) is a common cause of preventable morbidity and mortality for patients undergoing oncologic procedures [[1], [2], [3]]. Active malignancy, pelvic surgery, and prolonged immobilization are known risk factors for the development of VTE [2,4,5]. Prophylactic measures including sequential compression devices (SCDs), unfractionated heparin, low molecular weight heparin, and direct oral anticoagulants have demonstrated benefit in the prevention of VTE, particularly when both mechanical and chemoprophylactic methods are utilized [[6], [7], [8]]. While the utility of VTE prophylaxis in patients undergoing abdominopelvic surgery is well established [2,9], the benefit of VTE prophylaxis for women undergoing vulvar surgery for vulvar carcinoma is less clear [10].

Radical resection with inguinofemoral lymph node assessment remains the mainstay of treatment for clinically apparent early stage vulvar cancer [11]. In recent years, the advent of chemoradiotherapy for locally advanced vulvar carcinoma has led to decreased performance of radical vulvar surgery as a primary treatment modality [12,13]. Similarly, the introduction of sentinel lymph node biopsy for vulvar carcinoma following the publication of the GOG 173 and GROINS-V studies has continued to change the landscape of surgical management for patients with vulvar cancer, while reducing postoperative morbidity [14,15]. However, rates of VTE in this population are estimated to be between 1 and 4%, a metric derived from patients undergoing surgical resection prior to these paradigm shifts [5,16].

Despite the low rate of VTE following surgical resection for vulvar cancer patients, consideration of extended chemoprophylaxis is recommended by several organizations for this group. The American College of Chest Physicians (ACCP) 2012 CHEST guidelines, and the American Society of Clinical Oncology (ASCO) 2023 VTE prophylaxis guidelines recommend the use of extended chemoprophylaxis for any patient undergoing a procedure for a gynecologic malignancy for 28 days from hospital discharge [2,17]. Similarly, the American College of Obstetricians and Gynecologists (ACOG) recommends the consideration of extended chemoprophylaxis for 2–4 weeks postoperative for patients over the age of 60 undergoing major surgery in the presence of cancer, a molecularly hypercoagulable state, or prior VTE [18].

The benefit of extended VTE prophylaxis in patients undergoing vulvar surgery for vulvar carcinoma warrants further investigation. Limited data exist regarding the incidence of VTE in women undergoing resection for vulvar carcinoma and what patient specific factors pose the greatest risk for the development of postoperative VTE. Additionally, the incidence of VTE as it relates to method of inguinofemoral lymph node assessment has not been previously described. Prior literature has largely evaluated VTE rate in patients undergoing vulvar resection for pre-invasive or early stage disease without the incorporation of lymphadenectomy [10]. The purpose of this study was to define the incidence of postoperative VTE in a contemporary cohort of patients with vulvar cancer undergoing radical resection and to further determine VTE incidence among patients undergoing concurrent lymph node assessment with sentinel lymph node biopsy or complete inguinofemoral lymph node dissection.