The number of removed lymph nodes by inguinofemoral lymphadenectomy: impact on recurrence rates in patients with vulva carcinoma

Diehl, Anja; Volland, Ruth; Kirn, Verena; Thangarajah, Fabinshy; Eichler, Christian; Einzmann, Thomas; Wirtz, M; Ratiu, Dominik; Morgenstern, Bernd; Fridrich, C; Mallmann, Peter; Puppe, Julian

doi:10.1007/s00404-015-3932-6

Cited by 15 publications

(6 citation statements)

References 19 publications

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“…Furthermore, the surgery was performed in a consistent manner and by the same gynecological oncologists. The mean number of lymph nodes removed (7–8 lymph nodes per side) is in line with recommendations 36. There were slightly more pathological lymph nodes removed on the control side; however, this finding did not seem to influence the results toward more lymph production.…”

Section: Discussionsupporting

confidence: 81%

<p>Fibrin-thrombin sealant does not reduce lymphocele formation in patients with inguinofemoral lymphadenectomy for vulvar cancer</p>

Saner

Schötzau

Mackay

et al. 2019

CMAR

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Purpose: Inguinofemoral lymphadenectomy (IFLD) is associated with very high morbidity. Fibrin sealant patches are used in various surgical procedures to prevent hematomas and lymphoceles. Here, we report a single-institution experience of fibrin sealants after IFLD in vulvar cancer and give an overview of the current literature. Patients and methods: We retrospectively analyzed outcome data on vulvar cancer patients who underwent bilateral IFLD between November 2014 and June 2016 at the University Hospital Basel. A fibrin sealant patch (Tachosil ® ) was placed in one groin only. Postsurgical fluid collection and complications were compared between both groins; time courses of lymphocele formation were analyzed using a linear mixed-effects regression model. Results: Postsurgical outcome of 11 consecutive patients with bilateral IFLD for vulvar cancer was assessed for a median follow-up of 32 days (range 12–77). Significantly larger lymphoceles were detected over time in the groin with the fibrin sealant patch (median 20 mL vs 5 mL without patch, p =0.002), and more punctures for symptomatic lymphocele were required on this side. The infection rate did not differ between sides. Conclusion: Fibrin sealant patches should not routinely be used for prevention of lymphoceles after IFLD for vulvar cancer. They do not seem to reduce lymph collection, the need for puncture or the infection risk after lymphadenectomy in our experience and according to a general literature review.

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Section: Discussionsupporting

confidence: 81%

<p>Fibrin-thrombin sealant does not reduce lymphocele formation in patients with inguinofemoral lymphadenectomy for vulvar cancer</p>

Saner

Schötzau

Mackay

et al. 2019

CMAR

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“…In the present study, the DFS did not differ between the age groups for patients with affected LNs, suggesting that the nodal status as the most important independent prognostic factor for vulvar cancer [17,18,19] outweighs the age factor. This was different for patients with tumour-free LNs: In the present study, the DFS for patients >50 years was significantly better, even though there was a higher percentage of T2 tumours in this group.…”

Section: Discussionmentioning

confidence: 68%

The Impact of Age on the Prognosis of Vulvar Cancer

Hami

Lampe²,

Mallmann

et al. 2018

Oncol Res Treat

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Introduction: Younger women are particularly affected by the increase in the incidence of vulvar cancer. The purpose of this study was to investigate how clinical characteristics differ depending on the patient´s age and what role the age of initial diagnosis plays in the prognosis. Patients andMethods: Included patients were divided into groups aged below or above 50 years. The disease-free survival (DFS) was calculated and a multivariate discriminant analysis was conducted. Results: Of the 300 patients, 79 were ≤50 years and 221 were >50 years. The median age was 64 years (19-96 years). There were no differences between the groups regarding lymph node (LN) status and distant metastasis, but T1 tumours were more frequent in patients ≤50 years (77% vs. 62%, p = 0.02). The DFS only differed between the groups when there were no LN metastases. The nodal status was the predominant prognostic factor for the DFS regardless of age. In node-free patients, the 5-year DFS was 49% for the ≤50 years group and 89% for the >50 years group (p = 0.008), whereas there was no difference if a LN was involved. Conclusion: In node-free patients, the risk for recurrence is lower for patients older than 50 years.

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“…All patients with IB stage or resectable stage II vulvar cancer should undergo an inguinofemoral lymphadenectomy [ 49 ]. The risk of recurrence remains uncertain regarding the optimal number of resected lymph nodes [ 98 ]. The standard of care for radical vulvectomy with bilateral inguinofemoral lymphadenectomy remains the three-incision technique as it has good locoregional control and acceptable surgical morbidity [ 99 ].…”

Section: Treatmentmentioning

confidence: 99%

Management of Early-Stage Vulvar Cancer

Pedrão

Guimarães

Possati-Resende

et al. 2022

Cancers

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Vulvar cancer is a rare gynecological malignancy since it represents 4% of all cancers of the female genital tract. The most common histological type is squamous cell carcinoma (90%). This type can be classified into two clinicopathological subtypes according to the etiology. The first subtype is associated with persistent human papillomavirus infection and is usually diagnosed in younger women. The second subtype is associated with lichen sclerosus condition, and in most cases is diagnosed in postmenopausal women. Currently, an increase in first subtype cases has been observed, which raised the concern about associated mortality and treatment morbidity among young women. Vulvar cancer treatment depends on histopathology grade and staging, but surgery with or without radiotherapy as adjuvant treatment is considered the gold standard. In recent decades, sentinel lymph node biopsy has been incorporated as part of the treatment. Therefore, we sought to review and discuss the advances documented in the literature about vulvar cancer focusing on the treatment of early-stage disease. Relevant articles, such as the GROINS-V studies and the GOG protocols, are presented in this review. Additionally, we discuss key points such as the evolution of treatment from invasive surgery with high morbidity, to more conservative approaches without compromising oncologic safety; the role of sentinel lymph node mapping in the initial staging, since it reduces the complications caused by inguinofemoral lymphadenectomy; the recurrences rates, since local recurrence is common and curable, however, groin-associated, or distant recurrences have a poor prognosis; and, finally, the long-term follow-up that is essential for all patients.

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The number of removed lymph nodes by inguinofemoral lymphadenectomy: impact on recurrence rates in patients with vulva carcinoma

Abstract: In this cohort we demonstrated that resection of more than six LNs per groin does not improve the recurrence rates in patients with carcinoma of the vulva. Further prospective studies with more individuals are needed to evaluate the role of resected LNs in vulvar carcinoma.

Cited by 15 publications

References 19 publications

<p>Fibrin-thrombin sealant does not reduce lymphocele formation in patients with inguinofemoral lymphadenectomy for vulvar cancer</p>

<p>Fibrin-thrombin sealant does not reduce lymphocele formation in patients with inguinofemoral lymphadenectomy for vulvar cancer</p>

The Impact of Age on the Prognosis of Vulvar Cancer

Management of Early-Stage Vulvar Cancer

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