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Secondary Sentinel Node Biopsy After Previous Excision of the Primary Tumor in Squamous Cell Carcinoma of the Vulva

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

Abstract

Background

To reduce morbidity of radical groin dissection, the sentinel-node (SLN) procedure was implemented for the treatment of vulvar cancer. It has been proven to be a safe alternative in early-stage disease. Feasibility and safety of the procedure after previous vulvar surgery remain unclear.

Methods

A total of 106 patients with primary vulvar cancer undergoing the SLN procedure were analyzed. Seventy-four patients received the SLN procedure concomitant to vulvar surgery [primary-sentinel group (PSG)], whereas 32 patients had vulvar surgery before secondary SLN [secondary-sentinel group (SSG)].

Results

SLN detection was possible in all patients. Three (9.4 %) patients in the SSG and 30 (40.5 %) in the PSG had metastatic spread to the SLN and underwent radical groin dissection. Median interval between vulva surgery and secondary sentinel was 34 days (range, 7–98). In the SSG tumor, stages were earlier with smaller tumor size (median 19 mm in the PSG vs. 9 mm in the SSG) and lesser invasion depth (4 vs. 2 mm; p < 0.001). There were no groin recurrences in the SSG and 5.4 % in the PSG. No significant difference regarding disease-free survival (DFS) could be detected (3-year DFS of 72.5 % in the PSG compared with 92.5 % in the SSG (median DFS not reached, p = 0.114)). Adjusting for potential confounders (tumor stage, nodal status, tumor size, invasion depth) did not alter the results with regards to DFS.

Conclusions

Our results suggest that a secondary SLN procedure after previous vulvar surgery is feasible and can accurately reflect the groin status of selected patients. Ideally, prospective trials should be conducted to verify accuracy and oncologic safety of the procedure.

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Acknowledgment

This study was funded by internal departmental sources.

Conflict of interest

All authors declare that there are no conflicts of interest involved with the presented data. This study was funded by internal departmental sources.

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Authors and Affiliations

  1. Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Linn Woelber MD, Donata Grimm MD, Fabian Trillsch MD, Fritz Jaenicke MD, Joerg Schwarz MD & Sven Mahner MD

  2. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Eik Vettorazzi

  3. Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Christian Wisotzki MD

  4. Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Matthias Choschzick

Authors
  1. Linn Woelber MD
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  2. Donata Grimm MD
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  4. Christian Wisotzki MD
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  8. Matthias Choschzick
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  9. Sven Mahner MD
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Corresponding author

Correspondence to Linn Woelber MD.

Additional information

Linn Woelber and Donata Grimm contributed equally to this study.

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Woelber, L., Grimm, D., Vettorazzi, E. et al. Secondary Sentinel Node Biopsy After Previous Excision of the Primary Tumor in Squamous Cell Carcinoma of the Vulva. Ann Surg Oncol 20, 1701–1706 (2013). https://doi.org/10.1245/s10434-012-2735-2

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  • DOI: https://doi.org/10.1245/s10434-012-2735-2

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