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