Selective Removal of Only Clinically Suspicious Positive Lymph Nodes Instead of a Complete Inguino-Femoral Lymph Node Dissection in Squamous Cell Carcinoma of the Vulva

SIMPLE SUMMARY: When there is evidence for the spread of a vulvar tumor to the regional lymph nodes in the groins, local resection of the primary tumor and complete removal of these regional lymph nodes, which is frequently followed by radiotherapy, is recommended. This treatment results in significant side effects. Alternative treatment methods with fewer side effects are therefore being explored. In this study, 40 patients with evidence for spread of the tumor to the lymph nodes, resulting in large (bulky) nodes, were treated with removal of the enlarged lymph nodes only, followed by radiotherapy, leaving behind the nodes that looked normal. The survival of this group was compared with a similar group of 37 patients treated with the removal of all nodes in the groin(s). Although in both groups the survival rate was poor (5 years survival: 29.4% vs. 23.8%), there was no difference between the groups. Therefore, we recommend removing only bulky nodes in cases where there is a proven spread of the tumor in these nodes. ABSTRACT: Background. The oncological safety of only removing bulky, positive groin lymph nodes followed by radiotherapy without performing a complete inguino-femoral node dissection (IFL) in squamous cell cancer of the vulva is based on two small studies. The aim of this study was to confirm the oncological safety of this treatment policy. Methods. The survival of consecutive patients with clinically suspicious and pathologically positive groin nodes treated with the selective removal of these nodes followed by radiotherapy was compared with the survival in historical controls matched for the variables extranodal spread and diameter of the metastasis > 15 mm and treated with a complete IFL. Results. There was no difference in disease-specific survival between patients treated with debulking (n = 40) versus complete IFL (n = 37) (43.1% vs. 44.8%, p = 0.336, respectively). Overall, survival and groin recurrence-free survival did not differ between the groups either. Conclusion. This retrospective study in a cohort of women with vulvar cancer corroborates previous smaller studies that have shown that the selective removal of suspicious inguinal nodes yields similar oncological outcomes compared with patients matched for important prognostic variables and treated with a complete IFL when both are followed by radiotherapy.