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. 2022 Oct;167(1):3-10.
doi: 10.1016/j.ygyno.2022.07.017. Epub 2022 Sep 7.

Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe

W L Van der Kolk  1 , A G J Van der Zee  1 , B M Slomovitz  2 , P J W Baldwin  3 , H C Van Doorn  4 , J A De Hullu  5 , J Van der Velden  6 , K N Gaarenstroom  7 , B F M Slangen  8 , P Kjolhede  9 , M Brännström  10 , I Vergote  11 , C M Holland  12 , R Coleman  13 , E B L Van Dorst  14 , W J Van Driel  15 , D Nunns  16 , M Widschwendter  17 , D Nugent  18 , P A DiSilvestro  19 , R S Mannel  20 , M Y Tjiong  6 , D Boll  21 , D Cibula  22 , A Covens  23 , D Provencher  24 , I B Runnebaum  25 , B J Monk  26 , V Zanagnolo  27 , K Tamussino  28 , M H M Oonk  29 ; all GROINSS-V I and II participants
Collaborators, Affiliations
Free article

Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe

W L Van der Kolk et al. Gynecol Oncol. 2022 Oct.
Free article

Abstract

Objective: Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN.

Methods: We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up.

Results: Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was diagnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence.

Conclusion: The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases.

Keywords: Inguinofemoral lymphadenectomy; Lymph node metastases; Radiotherapy; Sentinel lymph node; Vulvar cancer.

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