Subscribe to RSS
DOI: 10.1055/a-1491-6405
Morbidity and quality of life in patients with vulvar cancer after inguinal sentinel lymphadenectomy compared to radical inguinofemoral lymphadenectomy
Morbidität und Lebensqualität von Patientinnen mit Vulvakarzinom nach inguinaler Sentinel-Lymphadenektomie im Vergleich zur radikalen inguinofemoralen Lymphadenektomie![](https://www.thieme-connect.de/media/10.1055-s-00034924/202105/lookinside/thumbnails/nuk-1163_10-1055-a-1491-6405-1.jpg)
Abstract
Aim Probability of survival of patients with vulvar cancer directly depends on the lymph node status. Surgery of lymph nodes can be performed as radical inguinofemoral lymphadenectomy or in cases with certain conditions as sentinel lymph node surgery. The aim of this study is to obtain an overview of the intervention-related morbidity and quality of life in patients with vulvar carcinoma after lymphadenectomy.
Methods Quality of life and morbidity was compared between patients who underwent radical inguinofemoral lymphadenectomy with those who underwent sentinel lymph node surgery.
Results All recorded postoperative complications occur more frequently in the non-sentinel group, Significant difference was shown for the occurrence of lymphedema (p-value = 0.024) and sensitivity loss (p-value = 0.024). Recurrence of disease was more frequent in the non-sentinel group (38 % vs. 20 %, p = 0.621, n.s.) and satisfaction with groin surgery is slightly higher in the sentinel group (94 % vs. 89 %, p = 1.000, n.s.).
Conclusion We could demonstrate a significantly lower morbidity of sentinel lymphadenectomy compared to conventional inguinofemoral lymphadenectomy while maintaining the same oncological safety. The low morbidity of sentinel- lymphadenectomy does not seem to influence the postoperative quality of life significantly. However, recording of the individual burden of lymphadenectomy by questionnaires should be optimized.
Zusammenfassung
Ziel Die Überlebenswahrscheinlichkeit von Patientinnen mit Vulvakarzinom hängt direkt vom Lymphknotenstatus ab. Die Resektion der Lymphknoten kann als radikale inguinofemorale Lymphadenektomie oder bei Vorliegen bestimmter Voraussetzungen als Sentinel-Lymphadenektomie durchgeführt werden. Ziel dieser Studie ist es, einen Überblick über die interventionelle Morbidität und Lebensqualität bei Patientinnen mit Vulvakarzinom nach Lymphadenektomie zu erhalten.
Methoden Lebensqualität und Morbidität wurden zwischen Patientinnen, bei denen eine radikale inguinofemorale Lymphadenektomie durchgeführt wurde, und Patientinnen, bei denen eine Sentinel-Lymphknotenchirurgie durchgeführt wurde, verglichen.
Ergebnisse Alle erfassten postoperativen Komplikationen traten in der Nicht-Sentinel-Gruppe häufiger auf, ein signifikanter Unterschied zeigte sich für das Auftreten von Lymphödemen (p = 0,024) und Sensibilitätsverlust (p = 0,024). Krankheitsrezidive traten in der Nicht-Sentinel-Gruppe häufiger auf (38 % vs. 20 %; p = 0,621, n.s.) und die Zufriedenheit mit dem Eingriff in der Leistenregion war in der Sentinel-Gruppe etwas höher (94 % vs. 89 %; p = 1,000, n.s.).
Schlussfolgerung Wir konnten eine signifikant geringere Morbidität der Sentinel-Lymphadenektomie im Vergleich zur konventionellen inguinofemoralen Lymphadenektomie bei gleichbleibender onkologischer Sicherheit nachweisen. Die niedrigere Morbidität bei der Sentinel-Lymphadenektomie hat keinen signifikanten Einfluss auf die postoperative Lebensqualität. Die Erfassung der individuellen Belastung durch die Lymphadenektomie mittels Fragebögen sollte jedoch optimiert werden.
Publication History
Received: 18 January 2021
Accepted: 21 April 2021
Article published online:
24 June 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Alkatout I, Schubert M, Garbrecht N. et al. Vulvar cancer: epidemiology, clinical presentation, and management options. Int J Womens Health 2015; 7: 305-313 DOI: 10.2147/IJWH.S68979.
- 2 Brinton LA, Thistle JE, Liao LM. et al. Epidemiology of vulvar neoplasia in the NIH-AARP Study. Gynecologic oncology 2017; 145: 298-304 DOI: 10.1016/j.ygyno.2017.02.030.
- 3 de Hullu JA, Hollema H, Piers DA. et al. Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2000; 18: 2811-2816 DOI: 10.1200/JCO.2000.18.15.2811.
- 4 Narayansingh GV, Miller ID, Sharma M. et al. The prognostic significance of micrometastases in node-negative squamous cell carcinoma of the vulva. British journal of cancer 2005; 92: 222-224 DOI: 10.1038/sj.bjc.6602343.
- 5 AWMF-Leitlinie. S3-Leitlinie: Diagnostik, Therapie und Nachsorge des Vulvakarzinoms und seiner Vorstufen. Stand 2015
- 6 RCOG. Guidelines for the Diagnosis and Management of Vulval Carcinoma. 2014
- 7 Podratz KC, Symmonds RE, Taylor WF. Carcinoma of the vulva: analysis of treatment failures. Am J Obstet Gynecol 1982; 143: 340-351 DOI: 10.1016/0002-9378(82)90823-7.
- 8 Imoto S, Inamine M, Kudaka W. et al. Prognostic factors in patients with vulvar cancer treated with primary surgery: a single-center experience. SpringerPlus 2016; 5: 125 DOI: 10.1186/s40064-016-1767-7.
- 9 Zhou J, Shan G. The prognostic role of FIGO stage in patients with vulvar cancer: a systematic review and meta-analysis. Current medical research and opinion 2016; 32: 1121-1130 DOI: 10.1185/03007995.2016.1162147.
- 10 Gaarenstroom KN, Kenter GG, Trimbos JB. et al. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society 2003; 13: 522-527 DOI: 10.1046/j.1525-1438.2003.13304.x.
- 11 Fotiou SK, Tserkezoglou AJ, Fragakis G. et al. “Butterfly” operation vs triple incision technique in vulvar cancer. a comparison of morbidity and clinical outcome. European journal of gynaecological oncology 1996; 17: 67-73
- 12 Wills A, Obermair A. A review of complications associated with the surgical treatment of vulvar cancer. Gynecologic oncology 2013; 131: 467-479 DOI: 10.1016/j.ygyno.2013.07.082.
- 13 Cirik DA, Karalok A, Ureyen I. et al. Early and Late Complications after Inguinofemoral Lymphadenectomy for Vulvar Cancer. Asian Pacific journal of cancer prevention: APJCP 2015; 16: 5175-5179 DOI: 10.7314/apjcp.2015.16.13.5175.
- 14 Schmidt MRB, Brenner W, Buck A. et al. Procedural instructions for the technical performance of nuclear medical sentinel lymph node diagnostics. In: German Society for Nuclear Medicine 2014.
- 15 Gunther V, Malchow B, Schubert M. et al. Impact of radical operative treatment on the quality of life in women with vulvar cancer--a retrospective study. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2014; 40: 875-882 DOI: 10.1016/j.ejso.2014.03.027.
- 16 Biermann CW, Kuchler T. Evaluation of Quality of Life in Oncology – Requirement or just an Option?. Onkologie 2000; 23: 485-486 DOI: 10.1159/000027225.
- 17 Mehlkop RGB. The effects of monetary incentives on the response rate in mail surveys on self-reported criminal behavior: theory and empirical results of an experiment Methoden, Daten, Analysen (mda). 2007 24.
- 18 Rouzier R, Haddad B, Dubernard G. et al. Inguinofemoral dissection for carcinoma of the vulva: effect of modifications of extent and technique on morbidity and survival. J Am Coll Surg 2003; 196: 442-450 DOI: 10.1016/S1072-7515(02)01895-1.
- 19 Van der Zee AG, Oonk MH, De Hullu JA. et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2008; 26: 884-889 DOI: 10.1200/JCO.2007.14.0566.
- 20 Te Grootenhuis NC, van der Zee AG, van Doorn HC. et al. Sentinel nodes in vulvar cancer: Long-term follow-up of the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I. Gynecologic oncology 2016; 140: 8-14 DOI: 10.1016/j.ygyno.2015.09.077.
- 21 Oonk MH, van Os MA, de Bock GH. et al. A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy. Gynecologic oncology 2009; 113: 301-305 DOI: 10.1016/j.ygyno.2008.12.006.