CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(12): 1221-1228
DOI: 10.1055/a-1120-0138
GebFra Science
Review/Übersicht

Pelvic Lymphadenectomy in Vulvar Cancer – Does it make sense?

Article in several languages: English | deutsch
Linn Woelber
1  Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Mareike Bommert
2  Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany
,
Katharina Prieske
1  Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
28  Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Inger Fischer
1  Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Christine zu Eulenburg
3  Department of Epidemiology, UMCG, Universität Groningen, Groningen, Netherlands
,
Eik Vettorazzi
4  Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Philipp Harter
2  Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany
,
Julia Jueckstock
5  Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
,
Felix Hilpert
6  Oncologic Medical Center at the Jerusalem Hospital Hamburg, Hamburg, Germany
,
Niko de Gregorio
7  Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany
,
Severine Iborra
8  Gynecology and Gynecologic Oncology, Uniklinik RWTH Aachen, Aachen, Germany
,
Jalid Sehouli
9  Department of Gynecology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
,
Atanas Ignatov
10  Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany
,
Peter Hillemanns
11  Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
,
Sophie Fuerst
5  Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
,
Hans-Georg Strauss
12  Department of Gynecology, University Hospital Halle, Halle, Germany
,
Klaus Baumann
13  Department of Gynecology, Medical Center Ludwigshafen, Ludwigshafen, Germany
,
Matthias Beckmann
14  Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
,
Alexander Mustea
15  Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, Bonn, Germany
,
Werner Meier
16  Department of Obstetrics and Gynecology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
,
Pauline Wimberger
17  Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
,
Lars Hanker
18  Department of Gynecology and Gynecologic Oncology, University Medical Center Lübeck, Lübeck, Germany
,
Ulrich Canzler
17  Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
,
Tanja Fehm
19  Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
,
Alexander Luyten
20  Department of Gynecology and Obstetrics, Medical Center Wolfsburg, Wolfsburg, Germany
,
Martin Hellriegel
21  Department of Gynecology and Gynecologic Oncology, University Medical Center Göttingen, Göttingen, Germany
,
Jens Kosse
22  Department of Gynecology and Obstetrics, Sana Klinikum Offenbach, Offenbach, Germany
,
Christoph Heiss
23  Department of Gynecology, Medical Center am Eichert, Alb Fils Clinic, Klinik am Eichert, Göppingen, Germany
,
Peer Hantschmann
24  Department of Gynecology and Obstetrics, Medical Center Altötting, Altötting, Germany
,
Peter Mallmann
25  Department of Gynecology and Gynecologic Oncology, University Medical Center Köln, Köln, Germany
,
Berno Tanner
26  Department of Gynecology and Obstetrics, Medical Center Oranienburg, Oranienburg, Germany
,
Jacobus Pfisterer
27  Gynecologic Oncology Center Kiel, Kiel, Germany
,
Sven Mahner
5  Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
,
Barbara Schmalfeldt
1  Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Anna Jaeger
1  Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations

Abstract

Since the publication of the updated German guideline in 2015, the recommendations for performing pelvic lymphadenectomy (LAE) in patients with vulvar cancer (VSCC) have changed considerably. The guideline recommends surgical lymph node staging in all patients with a higher risk of pelvic lymph node involvement. However, the current data do not allow the population at risk to be clearly defined, therefore, the indication for pelvic lymphadenectomy is still not clear. There are currently two published German patient populations who had pelvic LAE which can be used to investigate both the prognostic effect of histologically verified pelvic lymph node metastasis and the relation between inguinal and pelvic lymph node involvement. A total of 1618 patients with primary FIGO stage ≥ IB VSCC were included in the multicenter AGO CaRE-1 study (1998 – 2008), 70 of whom underwent pelvic LAE. During a retrospective single-center evaluation carried out at the University Medical Center Hamburg-Eppendorf (UKE), a total of 514 patients with primary VSCC treated between 1996 – 2018 were evaluated, 21 of whom underwent pelvic LAE. In both cohorts, around 80% of the patients who underwent pelvic LAE were inguinally node-positive, with a median number of three affected groin lymph nodes. There were no cases of pelvic lymph node metastasis without inguinal lymph node metastasis in either of the two cohorts. Between 33 – 35% of the inguinal node-positive patients also had pelvic lymph node metastasis; the median number of affected groin lymph nodes in these patients was high (> 4), and the maximum median diameter of the largest inguinal metastasis was > 40 mm in both cohorts. Pelvic lymph node staging and pelvic radiotherapy is therefore probably not necessary for the majority of node-positive patients with VSCC, as the relevant risk of pelvic lymph node involvement was primarily found in node-positive patients with high-grade disease. More, ideally prospective data collections are necessary to validate the relation between inguinal and pelvic lymph node involvement.



Publication History

Received: 09 July 2020

Accepted after revision: 12 October 2020

Publication Date:
03 December 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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