The Effect of Groin Treatment Modality and Sequence on Clinically Significant Chronic Lymphedema in Patients With Vulvar Carcinoma

Berger, Jessica; Scott, E.; Sukumvanich, Paniti; Smith, Amber; Olawaiye, Alexander; Comerci, John T.; Kelley, Joseph L.; Beriwal, Sushil; Huang, Marilyn

doi:10.1097/igc.0000000000000311

Cited by 17 publications

(7 citation statements)

References 28 publications

(23 reference statements)

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“…Conversely, in the study of Gould et al lower body lymphedema was neither predicted by early complications nor by other factors (use of antibiotics, adjuvant therapy, drainage) (59). The rates of lymphedema were not significantly different according to treatment modalities (single, combination or sequence) in the study of Berger et al (60). According to some authors preserving the saphenous vein during inguinal lymphadenectomy is associated with a lower risk of lymphedema (61), but this approach is not widely accepted.…”

Section: Incidencementioning

confidence: 57%

Lower Body Lymphedema in Patients with Gynecologic Cancer

Biglia

Zanfagnin

Daniele

et al. 2017

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Section: Incidencementioning

confidence: 57%

Lower Body Lymphedema in Patients with Gynecologic Cancer

Biglia

Zanfagnin

Daniele

et al. 2017

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“…Vulvar cancers, compared with other gynecologic malignancies, have a more reliable and predictable lymphatic drainage to the inguinofemoral nodal basins. Rates of lower extremity lymphedema after inguinofemoral lymphadenectomy range from 10% in retrospective reports43 to 73% in studies assessing patient-reported symptoms 8. In studies using a uniform methodology to diagnose lower extremity lymphedema across types of malignancy, the rates are consistently highest in vulvar cancer: based on a recent meta-analysis, the pooled incidence is 28.8% 5 39 44.…”

Section: Secondary Lymphedema In Gynecologic Malignanciesmentioning

confidence: 99%

“…In studies using a uniform methodology to diagnose lower extremity lymphedema across types of malignancy, the rates are consistently highest in vulvar cancer: based on a recent meta-analysis, the pooled incidence is 28.8% 5 39 44. This is mostly, but not entirely, related to inguinofemoral lymphadenectomy 43. Berger et al reported that 6.7% of patients with vulvar cancer treated with radiation alone developed chronic lower extremity lymphedema 43.…”

Section: Secondary Lymphedema In Gynecologic Malignanciesmentioning

confidence: 99%

“…This is mostly, but not entirely, related to inguinofemoral lymphadenectomy 43. Berger et al reported that 6.7% of patients with vulvar cancer treated with radiation alone developed chronic lower extremity lymphedema 43. Other risk factors include infection, extensive lymph node dissection, and postoperative adjuvant radiation therapy 44.…”

Section: Secondary Lymphedema In Gynecologic Malignanciesmentioning

confidence: 99%

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Lower extremity lymphedema in patients with gynecologic malignancies

Dessources

Aviki

Leitao

2020

Int J Gynecol Cancer

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Lower extremity lymphedema is a chronic, often irreversible condition that affects many patients treated for gynecologic malignancies, with published rates as high as 70% in select populations. It has consistently been shown to affect multiple quality of life metrics. This review focuses on the pathophysiology, incidence, trends, and risk factors associated with lower extremity lymphedema secondary to the treatment of cervical, endometrial, ovarian, and vulvar cancers in the era of sentinel lymph node mapping. We review traditional and contemporary approaches to diagnosis and staging, and discuss new technologies and imaging modalities. Finally, we review the data-based treatment of lower extremity lymphedema and discuss experimental treatments currently being developed. This review highlights the need for more prospective studies and objective metrics, so that we may better evaluate and serve these patients.

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“…Therefore, standard of care for vulvar cancer is surgical treatment with vulvectomy or wide radical excision of the primary tumor +/-complete inguinal lymph node dissection (ILND). However, ILND is often accompanied by surgical complications such as impaired wound healing, acute infections, and lymph edema [3,4]. Even with advanced surgical techniques [5], more than half of the patients are affected by post-operative complications.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Outcome after Sentinel Lymph Node Biopsy or Inguinal Lymph Node Dissection in Patients with Nodal Negative Squamous Vulvar Cancer

Ebner¹,

Antje²,

Schramm³

et al. 2017

Glob Surg

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Sentinel lymph node biopsy (SLNB) can reduce postoperative morbidity in women with vulvar cancer but data on long-term outcome of SLNB compared to inguinal lymph node dissection (ILND) is rare. Recurrence rates, disease-free survival (DFS) and overall survival (OS) from pT1/T2 pN0 squamous vulvar cancer from 1992 -2011 were retrospectively compared between patients with SLNB (n=56) or ILND (n=56). PT2 tumors (59% vs. 11%; p<0.001) and complete vulvectomy (39% vs. 4%; p < 0.001) occured more often in the ILND than the SLNB group with no difference in lymph node recurrence rate. Multivariate survival analysis considering the year of primary diagnosis, tumor stage and surgery revealed no significant effect of treatment on DFS (p=0.062) or OS (p=0.924). SLNB seems to be a safe treatment for women with pT1/T2 nodal-negative vulvar cancer with no difference in DFS or OS compared to ILND. Those results confirm the results of the GROINSS-V Study and other literature with the longest follow-up data reported within a real-life collective. Impact statementSLNB has been shown to reduce postoperative morbidity in women with vulvar cancer, however, data on long-term outcome of SLNB in vulvar cancer is rare. The aim of this study was to evaluate the outcome of patients with nodal-negative vulvar cancer that had undergone either SLNB or ILND in a clinical collective. Patients in the ILND group presented with more pT2 tumors (59% vs. 11%; p< 0.001) and followed by complete vulvectomy (39% vs. 4%; p <0.001). The lymph node recurrence rate was not significantly different between both groups (p=0.57). A multivariate survival analysis accounting for year of primary diagnosis, tumor stage and type of surgery revealed no significant effect of treatment on DFS or OS. SLNB seems to be a safe treatment for women with T1/T2 nodal-negative vulvar cancer, as we observed no difference in DFS or OS compared to patients with ILND. However, because of the observed bias between the two groups, results have to be interpreted carefully and need to be confirmed in larger prospective trials. Nevertheless, the results represent further data regarding the oncological safety of SNB supporting current literature and strongly underlie its value in the described setting with the longest follow-up, to date, reported.

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The Effect of Groin Treatment Modality and Sequence on Clinically Significant Chronic Lymphedema in Patients With Vulvar Carcinoma

Cited by 17 publications

References 28 publications

Lower Body Lymphedema in Patients with Gynecologic Cancer

Lower Body Lymphedema in Patients with Gynecologic Cancer

Lower extremity lymphedema in patients with gynecologic malignancies

Comparison of Outcome after Sentinel Lymph Node Biopsy or Inguinal Lymph Node Dissection in Patients with Nodal Negative Squamous Vulvar Cancer

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