The Risk of Contralateral Non-sentinel Metastasis in Patients with Primary Vulvar Cancer and Unilaterally Positive Sentinel Node

Abstract

In case of bilateral SLN biopsy for clinically node-negative disease and only unilaterally positive SLN, the risk for contralateral non-SLN metastases appears to be low. These data support the omission of contralateral LAE to reduce surgical morbidity.

Vulvar Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

“…For primary vulvar tumors <4 cm in diameter, located ≥2 cm from the vulvar midline, with clinically negative IFLNs, unilateral inguinofemoral lymphadenectomy or SLN biopsy are appropriate. 56,57 However, bilateral lymph node evaluation (full dissection or SLN biopsy, if indicated) is recommended for patients with primary tumors that are within 2 cm of, or crossing, the vulvar midline. 57 SLN Biopsy: Reported rates of postoperative morbidity with unilateral or bilateral inguinofemoral lymphadenectomy are high.…”

“…Patients with lateralized lesions (>1-mm invasion) located ≥2 cm from the vulvar midline should undergo radical local resection or modified radical vulvectomy accompanied by ipsilateral groin node evaluation. 56,57,72 Groin evaluation can be performed through SLN biopsy or ipsilateral IFLN dissection. Dissection should be performed if no SLNs are detected.…”

The Possibility of Contralateral Non-Sentinel Groin Node’s Metastasis in Early Primary Vulvar Cancer Women After Unilateral Sentinel Node’s Metastasis: A Single Center Evaluation in University Hospital of Düsseldorf

“…After the diagnosis has been established with biopsy (B), complete resection of tumor area 'residual zero' is the golden standard of current treatment. [3][4][5][6][7][8][9][10][11][12][13][14] The spread of VC cells is as follows: contiguously (expansion into neighborhood organs, such as vagina, urethra and anus), into the lymphatic system (from inguinal to femoral region, followed by pelvic lymph nodes) and lastly, hematogenously (distant metastases into liver, lungs and bones). 5 Complete (radical) dissection of inguinofemoral LN or lymphadenectomy (IFL), was formerly the standard treatment.…”

Lymphonodektomie beim Vulvakarzinom: Wann und wie vorgehen?

“…Eine Cut-off-Größe konnte jedoch nicht definiert werden. Im Unterschied dazu zeigte sich bei einer Metastasengröße über 2 mm ein signifikant schlechteres RFS [12].Woelber und Koautoren untersuchten ein Kollektiv von 140 Patientinnen mit beidseitiger SLNE[13]. In Fällen mit nur unilateral positivem Lymphkoten (n = 33) konnte bei 28 Patientinnen mit dann kompletter LNE keine kontralaterale Metastase gefunden werden.…”