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DOI: 10.1055/a-2541-2191
GebFra Science
Original Article

Sentinel Lymphonodectomy in Early Vulvar Cancer in Daily Practice: a Multicenter Experience from Germany

Sentinel-Lymphonodektomie bei Vulvakrebs im Frühstadium in der täglichen Praxis: eine multizentrische Erfahrung aus Deutschland
Philipp Soergel
1   University Women’s Hospital, Johannes Wesling Klinikum Minden, Ruhr University Clinic, Minden, Germany
,
Matthias Hempel
2   University Women’s Hospital, Hannover Medical School, Hannover, Germany
,
Julia Gallwas
3   Department of Gynecology and Obstetrics, University of Munich, Munich, Germany
4   Department of Gynecology and Obstetrics, University Hospital Göttingen, Göttingen, Germany
,
Christian Dannecker
5   Department of Obstetrics and Gynecology, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)
,
Linn Woelber
6   University Medical Center Hamburg-Eppendorf and Colposcopy Center at the Jerusalem Hospital, Hamburg, Germany
,
Ruediger Klapdor
2   University Women’s Hospital, Hannover Medical School, Hannover, Germany
,
Peer Hantschmann
7   Department of Obstetrics and Gynecology, Altötting Hospital, Altötting, Germany
,
Dirk M. Forner
8   Department of Obstetrics and Gynecology, Cologne-Kalk Hospital, Cologne, Germany
,
Paul Gass
9   Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
,
Monika Hampl
10   University Women’s Hospital, University Hospital of Düsseldorf, Düsseldorf, Germany
,
for the AGO Komission Vulva/Vagina › Author Affiliations
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Abstract

Objective

Inguinal sentinel lymph node dissection has been shown to be safe in early vulvar cancer in several studies and is considered or even recommended in many guidelines. The prognosis of inguinal recurrence is often poor and associated with significant mortality. To ensure an acceptably low false-negative rate and recurrence, vulvar sentinel lymph node dissection should only be performed using high-quality standards. This retrospective study aims to investigate the incidence of isolated groin recurrence in daily practice in six large cancer centers in Germany.

Methods

We identified all patients with early vulvar cancer in 2009–2015 who underwent inguinal sentinel lymphonodectomy and presented with node-negative final histologic results. Patient details regarding disease stage, sentinel procedure, and follow-up were examined using local cancer databases and patient registries.

Results

A total of 414 patients with available follow-up data were found, with a mean follow-up time of 38.4 months. The mean tumor size, measured in the dermal plane before surgery, was 40.0 mm, with a median tumor size of 36 mm. Isolated groin recurrence was found in 13 of 414 cases, leading to an isolated groin recurrence rate of 3.1%. The mean time to isolated groin recurrence was 17.7 months. There was no statistically significant association of any of the different quality requirements (tumor size < 4 cm, unifocal tumor, histologic ultra-staging, and preoperative exclusion of suspicious groins) with isolated groin recurrence.

Conclusion

Sentinel lymphadenectomy in vulvar cancer is a safe procedure in daily practice. The requirements of the cancer guidelines (unifocal tumor, ≤ 4 cm, histologic ultrastaging, and exclusion of suspicious groins preoperatively) should be followed to ensure a low isolated groin recurrence rate. However, in this study, we could not find any difference between the patients who fulfilled the guideline requirements and those who did not.

Zusammenfassung

Ziel

Mehrere Studien haben bestätigt, dass die Entfernung von Sentinel-Lymphknoten in der Leiste ein sicherer Eingriff bei Vulvakrebs im Frühstadium ist, und der Eingriff wird in vielen Leitlinien erwogen oder gar empfohlen. Die Prognose bei einem Rezidiv in der Leistengegend ist meist schlecht und geht mit einer signifikanten Mortalität einher. Um eine akzeptabel niedrige falsch negative Rate sicherzustellen und Rezidive zu vermeiden, sollte die Entfernung von Sentinel-Lymphknoten in der Leistengegend nur unter Einsatz hoher Qualitätsstandards durchgeführt werden. Ziel dieser retrospektiven Studie war es, das Auftreten von isolierten Leistenrezidiven in der täglichen Praxis in 6 großen Krebszentren in Deutschland zu untersuchen.

Methoden

Wir haben alle Patientinnen mit Vulvakrebs im Frühstadium ermittelt, die sich zwischen 2009 und 2015 einer Sentinel-Lymphonodektomie der Leiste unterzogen haben und deren endgültige histologische Ergebnisse nodal negativ waren. Die Patientenangaben zum Krankheitsstadium, Sentinel-Lymphonodektomie-Verfahren und Follow-up wurden mithilfe der örtlichen Krebsregister und Patientenregister geprüft.

Ergebnisse

Es fanden sich insgesamt 414 Patientinnen, bei denen Follow-up-Daten erhältlich waren. Die durchschnittliche Nachbeobachtungszeit betrug 38,4 Monate. Die vor der Operation kutan gemessene durchschnittliche Tumorgröße betrug 40,0 mm, die mittlere Tumorgröße war 36 mm. Isolierte Leistenrezidive traten bei 13 von 414 Fällen auf, was einer isolierten Leistenrezidivrate von 3,1% entspricht. Die durchschnittliche Zeit bis zum Auftreten eines isolierten Leistenrezidivs betrug 17,7 Monate. Es gab keinen statistisch signifikanten Zusammenhang zwischen den Qualitätsanforderungen (Tumorgröße < 4 cm, unifokaler Tumor, histologisches Ultrastaging, präoperativer Ausschluss bei Verdacht auf Leistenmetastasen) und einem isolierten Rezidiv in der Leiste.

Schlussfolgerung

Die Sentinel-Lymphonodektomie zur Behandlung von Vulvakrebs ist ein sicherer Eingriff in der täglichen Praxis. Es sollten die in den Krebsleitlinien geforderten Anforderungen (unifokaler Tumor, ≤ 4 cm, histologisches Ultrastaging sowie der präoperative Ausschluss bei Verdacht auf Leistenmetastasen) befolgt werden, um eine niedrige isolierte Rezidivrate in der Leiste zu gewährleisten. Wir konnten aber in dieser Studie keinen Unterschied zwischen Patientinnen, welche den Leitlinienanforderungen entsprachen, feststellen und denjenigen, die das nicht taten.

Info

What is already known on this topic

Inguinal sentinel lymph node dissection has been shown to be safe in early unifocal vulvar cancer in several studies and is considered or even recommended in many guidelines.

What this study adds

Sentinel lymphadenectomy in vulvar cancer patients is a safe procedure in daily practice in a real-world setting.

How this study might affect research, practice or policy

Sentinel lymphadenectomy in vulvar cancer can be routinely used in daily practice.

Keywords

vulvar cancer - sentinel - groin - vulva

Schlüsselwörter

Vulvakrebs - Sentinel - Leiste - Vulva


Publication History

Received: 24 October 2024

Accepted after revision: 16 February 2025

Article published online:
25 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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