Long‐term oncological outcomes of patients with negative sentinel lymph node in vulvar cancer. Comparative study with conventional lymphadenectomy

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 97; no. 12; pp. 1427 - 1437
• Main Authors: Rodríguez‐Trujillo, Adriano, Fusté, Pere, Paredes, Pilar, Mensión, Eduard, Agustí, Núria, Gil‐Ibáñez, Blanca, del Pino, Marta, González‐Bosquet, Eduardo, Torné, Aureli
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.12.2018
• Subjects: Adult; Aged; Aged, 80 and over; Biopsy; Cancer surgery; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Clinical outcomes; Female; Follow-Up Studies; Genital cancers; Groin; Gynecology; Humans; Lymph Node Excision - adverse effects; Lymph Node Excision - methods; lymphadenectomy; Lymphatic Metastasis; Lymphatic system; Middle Aged; Morbidity; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Postoperative Complications - epidemiology; Postoperative Complications - etiology; recurrence; Retrospective Studies; Risk Factors; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Surgical outcomes; survival; Survival Analysis; Treatment Outcome; vulvar cancer; Vulvar Neoplasms - mortality; Vulvar Neoplasms - pathology; Vulvar Neoplasms - surgery; recurrence; sentinel lymph node; vulvar cancer; survival; lymphadenectomy
• ISSN: 0001-6349; 1600-0412
• DOI: 10.1111/aogs.13431

Introduction The aim of this study was to compare oncological outcomes and morbidity in patients with early‐stage vulvar cancer with negative sentinel lymph node (SLN) biopsy vs negative inguinofemoral lymphadenectomy (IFL). Material and methods Study with retrospectively collected data in patients with squamous cell vulvar carcinomas ≤ 4 cm without suspected inguinofemoral lymph node metastases. Only patients with negative nodes after histopathology procedure were followed. Patients who underwent only SLN were compared with patients who underwent IFL ± SLN to compare recurrences, survival rates and morbidity. Results Ninety‐three patients were eligible for follow up: 42 with negative SLN and 51 with negative IFL ± SLN. The median follow‐up period was 60.4 months (range 6.7‐160.7). The rate of isolated first groin recurrence was 4.8% in patients with negative SLN and 2.0% in patients with negative IFL ± SLN (P = 0.587) and the rates of first isolated local recurrence were 28.6% and 31.4%, respectively (P = 0.823). Only 1 patient (2.4%) in the group of negative SLN had distant recurrence. The disease‐specific survival rate at 5 years was 83.3% in the negative SLN group and 92.2% in the negative IFL ± SLN group (P = 0.214). We observed a higher rate of wound breakdown and infection after IFL than SLN biopsy (17.6% vs 10.6%; P = 0.020) and lymphedema (33.3% vs 0%; P < 0.001). Conclusions We report in the same population of patients with early‐stage vulvar cancer that SLN biopsy does not have significantly higher rates of groin recurrences or lower survival rates compared with IFL. Moreover, the SLN procedure has less morbidity, which should encourage gynecologists to abandon IFL.