Skip to main content
Log in

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

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In patients with primary vulvar cancer and bilateral sentinel lymph node (SLN) biopsy, bilateral complete inguino-femoral lymphadenectomy (LAE) is recommended, even in cases with only unilaterally positive SLN by most guidelines. The risk of contralateral non-SLN metastasis is unclear.

Methods

All patients with primary vulvar cancer receiving an SLN dissection with radioactive tracer ± blue dye at the University Medical Center Hamburg-Eppendorf between 2001 and 2013 were retrospectively evaluated. Median follow-up was 33 months.

Results

A total of 140 patients were included; 124 with bilateral and 16 with unilateral SLN dissection. A median number of two SLNs (range 1–7) per groin were dissected. Overall, 53 (53/140, 37.9 %) patients received a complete inguino-femoral LAE, 41 of whom (77.4 %) had previously presented with a positive SLN (33 unilaterally, 8 bilaterally). Of the 33 patients with unilaterally positive SLN, 28 (84.9 %) underwent complete bilateral inguino-femoral LAE despite a contralateral negative SLN. Of these patients, none presented a contralateral non-SLN metastasis (0/28, 0 %) in full dissection; however, one developed groin recurrence in the initially SLN-negative, fully dissected groin after 19 months (1/28, 3.6 %).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mahner S, Jueckstock J, Hilpert F, et al. Adjuvant therapy in lymph node-positive vulvar cancer: The AGO-CaRE-1 Study. J Natl Cancer Inst. 2015;107:dju426.

  2. Van der Zee AG, Oonk MH, De Hullu JA, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008;26:884–9.

    Article  PubMed  Google Scholar 

  3. Burke TW, Levenback C, Coleman RL, et al. Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol. 1995;57:215–20.

    Article  CAS  PubMed  Google Scholar 

  4. Katz A, Eifel PJ, Jhingran A, Levenback CF. The role of radiation therapy in preventing regional recurrences of invasive squamous cell carcinoma of the vulva. Int J Radiat Oncol Biol Phys. 2003;57:409–18.

    Article  PubMed  Google Scholar 

  5. National German Guideline S2k (2015) Diagnosis, therapy, and follow-up care of vulvar cancer and its precursors. AWMF Registry No. 015/059.

  6. Hinten F, van den Einden LC, Hendriks JC, et al. Risk factors for short- and long-term complications after groin surgery in vulvar cancer. Br J Cancer. 2011;105:1279–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Magrina JF, Webb MJ, Gaffey TA, Symmonds RE. Stage I squamous cell cancer of the vulva. Am J Obstet Gynecol. 1979;134:453–9.

    CAS  PubMed  Google Scholar 

  8. Iversen T, Aas M. Lymph drainage from the vulva. Gynecol Oncol. 1983;16:179–89.

    Article  CAS  PubMed  Google Scholar 

  9. Hoffman MS, Roberts WS, Finan MA, et al. A comparative study of radical vulvectomy and modified radical vulvectomy for the treatment of invasive squamous cell carcinoma of the vulva. Gynecol Oncol. 1992;45:192–7.

    Article  CAS  PubMed  Google Scholar 

  10. Hacker NF, Berek JS, Lagasse LD, et al. Management of regional lymph nodes and their prognostic influence in vulvar cancer. Obstet Gynecol. 1983;61:408–12.

    CAS  PubMed  Google Scholar 

  11. Andrews SJ, Williams BT, DePriest PD, et al. Therapeutic implications of lymph nodal spread in lateral T1 and T2 squamous cell carcinoma of the vulva. Gynecol Oncol. 1994;55:41–46.

    Article  CAS  PubMed  Google Scholar 

  12. Hacker NF, Berek JS, Lagasse LD, et al. Individualization of treatment for stage I squamous cell vulvar carcinoma. Obstet Gynecol. 1984;63:155–62.

    CAS  PubMed  Google Scholar 

  13. Jeppesen JT, Sell A, Skjoldborg H. Treatment of cancer of the vulva. Acta Obstet Gynecol Scand. 1972;51:101–7.

    Article  CAS  PubMed  Google Scholar 

  14. Rutledge F, Smith JP, Franklin EW. Carcinoma of the vulva. Am J Obstet Gynecol. 1970;106:1117–30.

    Article  CAS  PubMed  Google Scholar 

  15. Krupp PJ, Bohm JW. Lymph gland metastases in invasive squamous cell cancer of the vulva. Am J Obstet Gynecol. 1978;130:943–52.

    Article  CAS  PubMed  Google Scholar 

  16. Gonzalez Bosquet J, Magrina JF, Magtibay PM, et al. Patterns of inguinal groin metastases in squamous cell carcinoma of the vulva. Gynecol Oncol. 2007;105:742–6.

  17. Beller U, Quinn MA, Benedet JL, et al. Carcinoma of the vulva. FIGO 26th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;95(Suppl 1):S7–27.

    Article  PubMed  Google Scholar 

  18. Benedet JL, Bender H, Jones H 3rd, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000;70:209–262.

    Article  CAS  PubMed  Google Scholar 

  19. Stehman FB, Bundy BN, Thomas G, et al. Groin dissection versus groin radiation in carcinoma of the vulva: a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys. 1992;24:389–96.

    Article  CAS  PubMed  Google Scholar 

  20. Cormio G, Loizzi V, Carriero C, et al. Groin recurrence in carcinoma of the vulva: management and outcome. Eur J Cancer Care (Engl). 2010;19:302–7.

    Article  CAS  Google Scholar 

  21. Stehman FB, Bundy BN, Dvoretsky PM, Creasman WT. Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstet Gynecol. 1992;79:490–7.

    CAS  PubMed  Google Scholar 

Download references

Funding

This study was funded by internal departmental sources.

Conflicts of interest

Linn Woelber, Christine Eulenburg, Donata Grimm, Fabian Trillsch, Inga Bohlmann, Eike Burandt, Jan Dieckmann, Susanne Klutmann, Barbara Schmalfeldt, Sven Mahner, and Katharina Prieske declare that there are no conflicts of interest involved with the presented data.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Linn Woelber MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Woelber, L., Eulenburg, C., Grimm, D. et al. The Risk of Contralateral Non-sentinel Metastasis in Patients with Primary Vulvar Cancer and Unilaterally Positive Sentinel Node. Ann Surg Oncol 23, 2508–2514 (2016). https://doi.org/10.1245/s10434-016-5114-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5114-6

Keywords

Navigation