Management of Regional Lymph Nodes and their Prognostic Influence on Vulvar Cancer

Hacker, Neville F.; Berek, J. S.; Lagasse, Leo D.; Leuchter, Ronald S.; Moore, James R.

doi:10.1007/978-1-4471-1389-8_26

Cited by 91 publications

(118 citation statements)

References 12 publications

(22 reference statements)

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“…Groin relapse in patients who had negative nodes at superficial inguinal lymphadenectomy in our series occurred in six patients, and it carried a very poor prognosis. Most patients with groin recurrence die of disease [31]. In our series, 10 of 11 patients with groin recurrences died of disease.…”

Section: Discussionmentioning

confidence: 55%

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Patterns and frequency of recurrences of squamous cell carcinoma of the vulva

Woolderink

Bock

Hullu

et al. 2006

Gynecologic Oncology

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Objective. To analyze patterns and frequency of recurrences of squamous cell carcinoma (SCC) of the vulva after wide local excision (WLE) and superficial inguinal lymphadenectomy with separate incisions and to identify prognostic factors for the development of recurrences.Methods. Between January 1985 and December 1999, all 125 consecutive patients with primary SCC of the vulva, treated with WLE and superficial inguinal lymphadenectomy, were retrospectively analyzed. Recurrences were registered by localization as: local, skin bridge, groin or distant.Results. A local recurrence was diagnosed in 29 (23%) patients, 11 (9%) developed a groin and 4 (3%) a distant recurrence. No skin bridge recurrences were identified. The 5 years local relapse-free survival was 70%. After a first local recurrence, 72% of these patients developed a second local recurrence. Adjusted for other predictors, older age (>74 years) is an independent risk factor for local recurrences (HR: 2.38; 95%-C. I.: 1.08-5.23) and stage III/IV cancer for developing groin/distant recurrences (HR: 3.03; 95%-C.I.: 1.0-9.18).Conclusion. WLE and superficial inguinal lymphadenectomy with separate incisions result in a high groin recurrence rate in this study; superficial lymphadenectomy should be replaced by deep inguinofemoral lymphadenectomy. After a local recurrence, 72% of the patients developed a second local recurrence. These patients are at high risk and need a close follow-up.

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Section: Discussionmentioning

confidence: 55%

“…The primary route of spread in vulvar cancer is by lymphatic embolization to the regional inguinofemoral lymph nodes. Especially the number of positive lymph nodes and extra-nodal tumor growth are of great importance for the prognosis of the patient [31,34].…”

Section: Discussionmentioning

confidence: 99%

Patterns and frequency of recurrences of squamous cell carcinoma of the vulva

Woolderink

Bock

Hullu

et al. 2006

Gynecologic Oncology

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“…Most of vulvar cancer recurrences occur in inguinal region and very rarely in the primary site of tumor excision (Magrina et al, 1979;Kelley et al, 1992;Sidor et al, 2006;Hampl et al, 2009). Several studies have described inguinal lymph node recurrences in up to 2.4% of cases (Hacker et al, 1983;Bell et al, 2000;Rodolakis et al, 2000;Ate van der Zee et al, 2008). Groin lymph-node metastases have been discovered as a most signifficant prognostic factors for vulvar cancer recurrence with a 5-year survival of 70-93% in patients with negative inguinofemoral lymph-nodes compared to 25-41% in patients with lymph-node metastases (Gadducci …”

Section: Introductionmentioning

confidence: 99%

Midline Involvement as a Risk Factor for Vulvar Cancer Recurrence

Stankeviča

Macuks²,

Baidekalna³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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“…node, 80% with two positive nodes, and 12% with three or more positive nodes [5]. In current practice, no effective preoperative method exists for detecting the presence of metastases within the inguinofemoral region -either via physical examination, diagnostic imaging or ultrasound-guided biopsy [6].…”

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confidence: 99%

“…In current practice, no effective preoperative method exists for detecting the presence of metastases within the inguinofemoral region -either via physical examination, diagnostic imaging or ultrasound-guided biopsy [6]. Since only 27% of women harbor nodal metastases, approximately 70% of women undergoing groin node dissection experience no therapeutic benefit, but 100% of women are subject to the associated surgical risk [5]. Owing to these factors, many gynecologic oncologists have shifted surgical m anagement to incorporate the SLNB technique.…”

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confidence: 99%

State of the Art of Sentinel Lymph Node Biopsy in Vulvar Carcinoma

McGee

Covens

2009

Womens Health (Lond Engl)

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Treatment for early-stage vulvar carcinoma has evolved from radical en bloc dissection to wide local incision with lymphadenectomy through separate groin incisions, to sentinel lymph node biopsy (SLNB). The morbidity of SLNB is far less than traditional inguinofemoral lymphadenectomy, with less lymphedema and sensory deficit, shorter hospital stays and fewer infections. A multidisciplinary approach is required, with success of the SLNB technique maximized when radiolabeled colloid is used, with blue dye added when further identification is needed. Frozen-section analysis, followed by ultrastaging of the nodal sample, minimizes the need for reoperations and decreases the risk of false negatives. We believe that SLNB will become the standard of care for treatment of early-stage vulvar carcinoma.

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Management of Regional Lymph Nodes and their Prognostic Influence on Vulvar Cancer

Cited by 91 publications

References 12 publications

Patterns and frequency of recurrences of squamous cell carcinoma of the vulva

Patterns and frequency of recurrences of squamous cell carcinoma of the vulva

Midline Involvement as a Risk Factor for Vulvar Cancer Recurrence

State of the Art of Sentinel Lymph Node Biopsy in Vulvar Carcinoma

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