From July 1, 1955 to March 31, 1989 24 patients with locally advanced vulvar cancer underwent ultraradical resection. Three patients had received prior radiotherapy. Seventeen of the 24 patients underwent posterior exenteration, four underwent anterior exenteration, and the remaining three required a total pelvic exenteration. One patient died 3 months postoperatively of fulminating infection considered to be a complication of the operation. Three other patients experienced serious complications, including postoperative hemorrhage, severe urinary sepsis, and colostomy stoma necrosis. Eleven (46%) of the 24 patients have remained alive without evidence of recurrent cancer for at least 3 years. Of the 10 patients known to have died of recurrent cancer, nine had positive lymph nodes at the time of surgery. It may be reasonable to utilize ultraradical surgery in patients with clearly resectable lesions who have negative or perhaps 1 or 2 microscopically positive regional lymph nodes.