The mandatory role of groin lymphadenectomy in clinical Stages IB and II vulvar cancer

Purpose of investigation: To analyze the prevalence of inguinofemoral lymph nodes metastases in clinical Stages IB-Ⅱ vulva cancer. Materials and Methods: Twenty-two patients with FIGO Stages IB-Ⅱ FIGO vulva cancer with no clinically and imagistic evidence of nodes metastases were treated in the present clinic. The surgical procedures consisted in radical vulvectomy plus inguinofemoral lymphadenectomy. Results: The final pathological result was squamous carcinoma in 20 patients, vulva melanoma in one, and carcinosarcoma in one. The prevalence of positive lymph nodes was 45.4%. The median number of harvested lymph nodes was 14.0 per groin (between four and 27). Twelve patients (54.5%) developed some wound complications, but all were resolved. At the present time, 20 patients are alive, but the follow-up period is short for many of them; two patients died of disease. Conclusion: The prevalence of groin metastases in Stages IB-Ⅱ vulvar cancer is high. A thorough inguino-femoral dissection seems necessary, despite the high incidence of wound complications.

Vulvar cancer; Lymphadenectomy.

[1] Hacker N.F.: “Vulvar cancer”. In: Berek J.S., Hacker N.F. (eds). Practical gynecologic oncology, 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2004, 543.

[2] Milam M., Levenback C.F.: “Vulvar cancer”. In: Karlan B.Y., Bristow R.E., Li A.J. (eds). Gynecologic oncology. Clinical practice & surgical atlas. New York: Mc Graw Hill, 2012, 173.

[3] Pecorelli S.: “Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium”. Int. J. Gynaecol. Obstet., 2009, 105, 103.

[4] Mutch D.G.: “The New FIGO staging system for cancers of the vulva, cervix, endometrium, and sarcomas”. Gynecol. Oncol., 2009, 115, 325.

[5] Hopkins M.P., Reid G.C., Johnston C.M., Morley G.W.: “A comparison of staging systems for squamous cell carcinoma of the vulva”. Gynecol. Oncol., 1992, 47, 34.

[6] Fons G., Hyde S.E., Buist M.R., Schilthuis M.S., Grant P., Burger M.P., van der Velden J.: “Prognostic value of bilateral positive nodes in squamous cell cancer of the vulva”. Int. J. Gynecol. Cancer, 2009, 19, 1276.

[7] van Beekhuizen H.J., Auzin M., van den Einden L.C.G., de Hullu J.A., van der Velden J., Wildhagen M.F., van Doorn H.C.: “Lymph nodes count at inguinofemoral lymphadenectomy and groin recurrence in vulvar cancer”. Int. J. Gynecol. Cancer, 2014, 24, 773.

[8] Hyde S.E., Ansink A.C., Burger M.P., Schilthuis M.S., van der Velden J.: “The impact of performance status on survival in patients of 80 years and older with vulvar cancer”. Gynecol. Oncol., 2002, 84, 388.

[9] van der Velden J., van Lindert A.C., Lammes F.B., ten Kate F.J., Sie-Go D.M., Oosting H., Heintz A.P.: “Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. The impact on recurrence and survival”. Cancer, 1995, 75, 2885.

[10] van der Velden J., Hacker N.F.: “Prognostic factors in squamous cell cancer of the vulva and the implications for treatment”. Curr. Opin. Obstet. Gynecol., 1996, 8, 3.

[11] Raspagliesi F., Hanozet F., Ditto A., Solima E., Zanaboni F., Vecchione F., Kusamura S.: “Clinical and pathological prognostic factors in squamous cell carcinoma of the vulva”. Gynecol. Oncol., 2006, 102, 333.

[12] Hyde S.E., Valmadre S., Hacker N.F., Schilthuis M.S., Grant P.T., van der Velden J.: “Squamous cell carcinoma of the vulva with bulky positive groin nodes—nodal debulking versus full groin dissection prior to radiation therapy”. Int. J. Gynecol. Cancer, 2007, 17, 154.

[13] Butler J.S., Milliken D.A., Dina R., Eccles S.A., Maghami S.G., Jameson C., et al.: “Isolated groin recurrence in vulval squamous cell cancer (VSCC). The importance of node count”. Eur. J. Gynaecol. Oncol., 2010, 31, 510.

[14] Courtney-Brooks M., Sukumvanich P., Beriwal S., Zorn K.K., Richard S.D., Krivak T.C.: “Does the number of nodes removed impact survival in vulvar cancer patients with node-negative disease?” Gynecol. Oncol., 2010, 117, 308.

[15] Cheng X., Zang R., Wu X., Li Z., Cai S, Zhang Z.: “Recurrence patterns and prognostic factors in Chinese patients with squamous cell carcinoma of the vulva treated with primary surgery”. Int. J. Gynecol. Cancer, 2009, 19, 158.