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Geburtshilfe Frauenheilkd 2013; 73(2): 142-147
DOI: 10.1055/s-0032-1328133
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Use of the Sentinel Lymph Node Technique Compared to Complete Inguino-femoral Lymph Node Removal in Patients with Invasive Vulvar Cancer in Germany

Verbreitung der Sentinellymphknotentechnik im Vergleich zur kompletten inguinofemoralen Lymphknotenentfernung beim invasiven Vulvakarzinom in Deutschland
F. Kramer
1   Gynecology and Obstetrics, Medical School Hanover, Hanover
,
H. Hertel
1   Gynecology and Obstetrics, Medical School Hanover, Hanover
,
P. Hillemanns
1   Gynecology and Obstetrics, Medical School Hanover, Hanover
› Author Affiliations
Further Information

Publication History

received 26 June 2012
revised 31 October 2012

accepted 13 December 2012

Publication Date:
07 March 2013 (online)

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Abstract

In the current S2 guidelines, the standard surgical therapy for patients with vulvar cancer also includes inguino-femoral lymphadenectomy. However, in view of the severe side-effects associated with this approach such as problems with wound healing, lymphoceles and lymphoedema, the search is on for alternative treatments that could decrease treatment-associated morbidity and improve patientsʼ quality of life, particularly for node-negative patients. The sentinel lymph node technique is currently the gold standard in the treatment of unifocal breast cancer (clinically negative axilla), and studies on the use of this technique in the treatment of vulvar cancer are promising. To date, the diagnostic accuracy of this method in vulvar cancer has only been evaluated in a single, one-arm, non-randomised, multicentre study. In preparation for a multicentre study, in 2010 we surveyed 41 German hospitals to investigate how often they used the sentinel lymph node technique compared to inguino-femoral lymphadenectomy. The hospitals were grouped according to hospital size and number of patients treated for vulvar cancer. The decision criteria to determine the type of procedure performed were also investigated. Finally, the hospitals were asked whether they would be willing to participate in a prospective clinical study to evaluate the sentinel lymph node technique in patients with vulvar cancer. The majority of surgeons questioned (73 %) already had some experience with this technique in patients with vulvar cancer. In our survey, 27 % of hospitals carried out inguino-femoral lymphadenectomy, 10 % used the sentinel lymph node technique, and 63 % used both methods. In 24 % of hospitals, the standard procedure consisted of the sentinel lymph node technique supplemented by inguino-femoral lymphadenectomy. Only 20 % of the institutions surveyed in our study carried out sentinel lymph node biopsy alone in accordance with the criteria of the consensus recommendations. The majority of the investigated institutions were willing to participate in a randomised prospective clinical study to evaluate the effectiveness of sentinel lymph node sampling in patients with vulvar cancer.

Zusammenfassung

Die inguinofemorale Lymphonodektomie stellt nach aktuellen Leitlinien das Standardverfahren beim Vulvakarzinom dar. Aufgrund erhöhter Raten an Wundheilungsstörungen, Lymphozelen und Lymphödemen könnten alternative Behandlungsmethoden insbesondere für nodalnegative Patientinnen zu einer Senkung der krankheitsassoziierten Morbidität und zu einer Steigerung der Lebensqualität führen. Die Sentinellymphonodektomie stellt beim unifokalen Mammakarzinom (klinisch unauffällige Axilla) den Goldstandard dar, und Studien zum Einsatz beim Vulvakarzinom weisen vielversprechende Ergebnisse auf. Bisher wurde in lediglich einer einarmigen, nicht randomisierten Studie die Wertigkeit dieser Methode überprüft. In einer Umfrage unter 41 deutschsprachigen Kliniken wurde 2010 die Verbreitung der Sentinellymphknotentechnik im Vergleich zur inguinofemoralen Lymphonodektomie erfasst. Die Kliniken wurden nach Größe und nach Anzahl der Vulvakarzinom-Patientinnen unterteilt. Erfasst wurde, welche Art der Lymphonodektomie nach welchen Entscheidungskriterien angewandt wird. Abschließend wurde die Bereitschaft zur Teilnahme an einer klinisch-prospektiven Studie zur Evaluation der Sentinellymphonodektomie beim Vulvakarzinom ermittelt. Die Mehrheit der Befragten (73 %) hatte Erfahrung mit dieser Technik beim Vulvakarzinom. In 27 % der Kliniken wurde die inguinofemorale, in 10 % die Sentinellymphonodektomie und in 63 % wurden beide Methoden angewandt. Eine Komplettierung der Sentinellymphknotentechnik wurde in 24 % der Kliniken grundsätzlich durchgeführt. Bei der Sentinellymphonodektomie gaben 20 % der Befragten an, gemäß Kriterien zu verfahren, die in den Konsensusempfehlungen empfohlen wurden. Die Mehrheit der befragten Kliniken würde an einer randomisierten klinisch-prospektiven Studie zur Evaluation der Wertigkeit der Sentinellymphonodektomie beim Vulvakarzinom teilnehmen.

Key words

Vulvar cancer - sentinel lymph node dissection - complete inguino-femoral lymphadenectomy

Schlüsselwörter

Vulvamalignom - Sentinellymphonodektomie - komplette inguinofemorale Lymphonodektomie

Supporting Information

 

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