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Sopracordevole F, Azzalini G, Clemente N, Del Fabro A, Giorda G, Fichera M, Gigante M, Bogani G, Canzonieri V. Primary intestinal-type adenocarcinoma of the vulva. A case report and review of the literature. Gynecol Oncol Rep 2023; 47:101193. [PMID: 37138644 PMCID: PMC10149392 DOI: 10.1016/j.gore.2023.101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 05/05/2023] Open
Abstract
Background Primary non-squamous cell carcinomas of the vulva are rare entities including various tumor types. Among these, primary vulvar intestinal-type adenocarcinoma (vPITA) is extremely rare. Until 2021, less than twenty-five cases have been reported in the literature. Case presentation We report a case of vPITA in a 63 years old woman with a histopathological diagnosis of signet-ring cell intestinal type adenocarcinoma at vulvar biopsy. Accurate clinical and pathological work-up excluded secondary metastatic localization, and vPITA was diagnosed. The patient was treated with radical vulvectomy and bilateral inguinofemoral dissection. Adjuvant chemo-radiotherapy was performed because of a positive lymph node. At 20 months follow-up the patient was alive and free of disease. Conclusion The prognosis of this very rare disease is unclear and optimal treatment is not well established. About 40% of clinical early-stage diseases reported in literature had positive inguinal nodes, more than in vulvar squamous cell carcinomas. A proper histopathologic and clinical diagnosis is mandatory to exclude secondary disease and to recommend an adequate treatment.
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Affiliation(s)
- Francesco Sopracordevole
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Giulia Azzalini
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Nicolò Clemente
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
- Corresponding author at: Gynecological Oncology Unit, Centro di Riferimento Oncologico (CRO) IRCCS, Via F Gallini 2, Aviano (PN), Italy.
| | - Anna Del Fabro
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Mariasole Fichera
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Marco Gigante
- Radiation Oncology Department, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Vincenzo Canzonieri
- Pathology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
- Pathology Unit, Health and Medical Science Department, University of Trieste, Italy
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Caretto AA, Stefanizzi G, Fragomeni SM, Federico A, Tagliaferri L, Lancellotta V, Scambia G, Gentileschi S. Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap. Cancers (Basel) 2022; 14:1076. [PMID: 35205824 DOI: 10.3390/cancers14041076] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
Inguinofemoral lymphadenectomy, frequently performed for vulvar cancer, is burdened with substantial immediate and long-term morbidity. One of the most disabling treatment-related sequelae is lower limb lymphedema (LLL). The present study aims to describe the wound complications and the severity of LLL in patients who have undergone groin dissection for vulvar cancer and immediate inguinal reconstruction with the Lymphatic Superficial Circumflex Iliac Perforator flap (L-SCIP). We retrospectively reviewed the data of patients who underwent bilateral groin dissection and unilateral inguinal reconstruction with the L-SCIP. The presence and severity of postoperative LLL during the follow-up period were assessed by lymphoscintigraphy and limbs' volume measurement. In addition, immediate complications at the level of the inguinal area were registered. The changes between preoperative and postoperative limb volumes were analyzed by Student's t test. p values < 0.05 were considered significant. Thirty-one patients were included. The mean variation of volume was 479 ± 330 cc3 in the side where groin reconstruction had been performed, and 683 ± 425 cc3 in the contralateral side, showing smaller variation in the treated side (p = 0.022). Lymphoscintigraphy confirmed the clinical findings. Based on our results, inguinal reconstruction with L-SCIP performed at the same time of groin dissection in patients treated for vulvar cancer can provide a significant protective effect on LLL.
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Micheletti L, Borella F, Preti M, Frau V, Cosma S, Privitera S, Bertero L, Benedetto C. Perineural Invasion in Vulvar Squamous-Cell Carcinoma Is an Independent Risk Factor for Cancer-Specific Survival, but Not for Locoregional Recurrence: Results from a Single Tertiary Referral Center. Cancers (Basel) 2021; 14:cancers14010124. [PMID: 35008288 PMCID: PMC8750970 DOI: 10.3390/cancers14010124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Vulvar squamous cell carcinoma is a rare tumor but represents a serious health issue, especially due to the increasing incidence over the past decades. Many efforts have been made to identify new prognostic and therapeutic factors and, in this context, growing evidence concerning a pivotal role of perineural invasion. With this study, we investigated the role of perineural invasion in a large cohort of FIGO stage Ib-IIIc vulvar squamous cell carcinomas and found that perineural invasion-positive tumors have more aggressive biological behaviors and showed reduced cancer-specific survival as compared to perineural invasion-negative tumors, while this feature does not appear to be related to a greater risk to develop loco-regional recurrence. Further evaluations are warranted to confirm the prognostic role of perineural invasion and its potential use to tailor adjuvant treatment. Abstract The aims of this study were to assess the prevalence of perineural invasion (PNI) in vulvar squamous cell carcinoma (VSCC) and its prognostic role in locoregional recurrence (LRR) and cancer-specific survival (CSS). We performed a retrospective analysis of 223 consecutive stage IB–IIIC surgically treated VSCCs at S. Anna Hospital, University of Turin, from 2000 to 2019. We identified 133/223 (59.6%) patients with PNI-positive VSCCs. PNI was associated with aggressive biological features (i.e., advanced FIGO stage, larger tumor diameter, greater depth of invasion, a higher number of metastatic lymph nodes, and lymphovascular invasion) and shorter 5-year CSS (78% vs. 90%, log-rank p = 0.02) compared with PNI-negative VSCCs. Multivariate analysis showed that PNI (HR 2.99 CI 95% 1.17–7.63; p = 0.02) and the presence of tumor cells on pathological surgical margins (HR 3.13 CI 95% 1.37–7.13; p = 0.007) are independent prognostic factors for CSS. PNI does not appear to be related to LRR, but is an independent prognostic factor for worse survival outcomes. Future studies are necessary to explore the possible value of PNI in tailoring the choice of adjuvant treatment.
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Affiliation(s)
- Leonardo Micheletti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, 10126 Turin, Italy; (L.M.); (M.P.); (V.F.); (S.C.); (C.B.)
| | - Fulvio Borella
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, 10126 Turin, Italy; (L.M.); (M.P.); (V.F.); (S.C.); (C.B.)
- Correspondence: ; Tel.: +39-34-7047-2715
| | - Mario Preti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, 10126 Turin, Italy; (L.M.); (M.P.); (V.F.); (S.C.); (C.B.)
| | - Valentina Frau
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, 10126 Turin, Italy; (L.M.); (M.P.); (V.F.); (S.C.); (C.B.)
| | - Stefano Cosma
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, 10126 Turin, Italy; (L.M.); (M.P.); (V.F.); (S.C.); (C.B.)
| | - Sebastiana Privitera
- Pathology Unit, Department of Medical Science, University of Turin, 10126 Turin, Italy; (S.P.); (L.B.)
| | - Luca Bertero
- Pathology Unit, Department of Medical Science, University of Turin, 10126 Turin, Italy; (S.P.); (L.B.)
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, 10126 Turin, Italy; (L.M.); (M.P.); (V.F.); (S.C.); (C.B.)
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Saner FA, Schötzau A, Mackay G, Heinzelmann-Schwarz V, Montavon Sartorius C. Fibrin-thrombin sealant does not reduce lymphocele formation in patients with inguinofemoral lymphadenectomy for vulvar cancer. Cancer Manag Res 2019; 11:3575-3582. [PMID: 31118780 PMCID: PMC6503303 DOI: 10.2147/cmar.s197143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/19/2019] [Indexed: 01/07/2023] Open
Abstract
Purpose: Inguinofemoral lymphadenectomy (IFLD) is associated with very high morbidity. Fibrin sealant patches are used in various surgical procedures to prevent hematomas and lymphoceles. Here, we report a single-institution experience of fibrin sealants after IFLD in vulvar cancer and give an overview of the current literature. Patients and methods: We retrospectively analyzed outcome data on vulvar cancer patients who underwent bilateral IFLD between November 2014 and June 2016 at the University Hospital Basel. A fibrin sealant patch (Tachosil®) was placed in one groin only. Postsurgical fluid collection and complications were compared between both groins; time courses of lymphocele formation were analyzed using a linear mixed-effects regression model. Results: Postsurgical outcome of 11 consecutive patients with bilateral IFLD for vulvar cancer was assessed for a median follow-up of 32 days (range 12–77). Significantly larger lymphoceles were detected over time in the groin with the fibrin sealant patch (median 20 mL vs 5 mL without patch, p=0.002), and more punctures for symptomatic lymphocele were required on this side. The infection rate did not differ between sides. Conclusion: Fibrin sealant patches should not routinely be used for prevention of lymphoceles after IFLD for vulvar cancer. They do not seem to reduce lymph collection, the need for puncture or the infection risk after lymphadenectomy in our experience and according to a general literature review.
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Affiliation(s)
- Flurina Am Saner
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas Schötzau
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gillian Mackay
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland.,Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Céline Montavon Sartorius
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland
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Sopracordevole F, Clemente N, Giorda G, Canzonieri V, Alessandrini L, del Fabro A, Serri M, Ciavattini A. Number of Nodes Removed With Inguinofemoral Lymphadenectomy and Risk of Isolated Groin Recurrence in Women With FIGO Stage IB–II Squamous Cell Vulvar Cancer. Int J Gynecol Cancer 2018; 28:1600-5. [DOI: 10.1097/igc.0000000000001326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AimThe aim of this study was to evaluate if the lymph node count from inguinofemoral lymphadenectomy impacted the risk of isolated groin recurrence in patients with node-negative squamous cell vulvar cancer.Materials and MethodsThis is a retrospective cohort study of women with squamous cell vulvar cancer (stage IB–II according to the 2009 Revised International Federation of Gynecology and Obstetrics staging system) who underwent primary radical vulvar surgery and groin lymphadenectomy between January 2005 and December 2014. Patients' sociodemographic characteristics, the disease characteristics, the number of nodes removed from each groin, and the oncologic outcome were evaluated. A cutoff value of at least 6 nodes removed from each groin was used to define the adequacy of inguinofemoral dissection.ResultsSeventy-six patients, fulfilling the study inclusion criteria, were considered. The mean number of nodes removed (bilaterally) was 14.5 (±5.3, SD), with a range of 2 to 29 nodes. Thirty-three women (43.4%) had less than 6 nodes removed from each groin. In the whole study cohort, 4 cases of isolated groin recurrence (5.3%) were detected, and all these recurrences developed in patients with less than 6 nodes removed. Considering the demographic, clinical, and histopathological characteristics potentially related to the risk of groin recurrence, only the number of nodes removed showed a significant correlation.ConclusionsWomen treated for vulvar cancer in which less than 6 nodes are removed from each groin are at higher risk of groin recurrence.
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Micheletti L, Preti M, Cintolesi V, Corvetto E, Privitera S, Palmese E, Benedetto C. Prognostic impact of reduced tumor-free margin distance on long-term survival in FIGO stage IB/II vulvar squamous cell carcinoma. J Gynecol Oncol 2018; 29:e61. [PMID: 30022627 PMCID: PMC6078886 DOI: 10.3802/jgo.2018.29.e61] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We aimed to identify the minimum tumor-free margin distance conferring long-term oncological safety in patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB/II vulvar squamous cell carcinoma (VSCC). METHODS This was a retrospective cohort study in patients with stage IB/II VSCC treated at a single institution in Turin, Italy. The main aim was to identify the minimum tumor-free margin distance that confers oncological safety in early-stage VSCC. Patients were divided in groups according to tumor-free histological margin distance to compare survival outcomes. Overall survival (OS), disease-specific survival (DSS), and recurrence rate (RR) were estimated by the Kaplan-Meier method for the newly proposed and the currently recommended 8 mm margin cut-off. Log-rank test was used to compare survival between groups. RESULTS One hundred and fourteen patients met the study criteria. Median age was 68 years and median follow-up was 80 months. The minimum margin distance that conferred long-term oncological safety was 5 mm. OS, DSS were significantly lower in the <5 mm group when compared with the ≥5 mm group (p=0.002 and p=0.033, respectively) although no difference in RR was observed between groups. Analysis at the 8-mm cut-off indicated there is no difference in OS, DSS, or RR between groups. CONCLUSION FIGO stage IB/II VSCC patients' prognosis is affected by margin distance. Long-term survival is significantly reduced in patients with tumor-free margins <5 mm, even in the absence of lymph node metastasis. Thus, these patients should be offered further surgical or adjuvant treatment.
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Affiliation(s)
- Leonardo Micheletti
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Torino, Turin, Italy.
| | - Mario Preti
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Torino, Turin, Italy
| | - Viviana Cintolesi
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Torino, Turin, Italy
| | - Elisabetta Corvetto
- Department of Surgical Sciences, Institute of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - Silvana Privitera
- Department of Pathology and Cytology of Female Cancer, Childhood Cancer, and Rare Cancers, AOU Città della Salute e della Scienza, Turin, Italy
| | - Eleonora Palmese
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Torino, Turin, Italy
| | - Chiara Benedetto
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Torino, Turin, Italy
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Zhang M, Chen L, Zhang X, Ding J, Hua K. A Comparative Study of Video Endoscopic Inguinal Lymphadenectomy and Conventional Open Inguinal Lymphadenectomy for Treating Vulvar Cancer. Int J Gynecol Cancer 2017; 27:1983-9. [PMID: 28885273 DOI: 10.1097/IGC.0000000000001100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aims to compare the complications, oncological outcomes, cosmetic satisfaction, and quality of life experienced by women with vulvar cancer undergoing video endoscopic inguinal lymphadenectomy (VEIL) versus conventional open inguinal lymphadenectomy (COIL). PATIENTS AND METHODS Forty-eight consecutive patients with vulvar cancer who underwent COIL (n = 27) or VEIL (n = 21) at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China between 2003 and 2016 were included in this retrospective cohort study. The perioperative data, postoperative complications, oncological outcomes, cosmetic satisfaction, and quality of life of the COIL and VEIL groups were compared. RESULTS Twenty patients (74.1%) in the COIL group and 19 patients (90.5%) in the VEIL group returned for follow-up after the operation. The median follow-up time was 73 months (8-162 months) for the COIL group and 28 months (8-58 months) for the VEIL group. The inguinal lymph node yield in the VEIL group was comparable with that in the COIL group (15 ± 5 vs 18 ± 6, P = 0.058). The VEIL and COIL groups had a similar 2-year recurrence rate (10.5% vs 10%, P = 0.957) and 2-year disease-specific survival rate (95.5% vs 93.3%, P = 0.724). The wound complication rate was significantly lower in the VEIL group than the COIL group (4.8% vs 55.6%, P = 0.000). The VEIL group had higher body image scores (16.27 ± 1.20 vs 13.16 ± 0.87, P < 0.0001) and cosmetic scores (20.13 ± 0.98 vs 16.92 ± 0.72, P < 0.0001) than the COIL group. The patients in the VEIL group had higher life quality scores on the Functional Assessment of Cancer Therapy-Vulvar questionnaire than those in the COIL group (165.9 ± 6.3 vs 160.5 ± 6.0, P = 0.026). CONCLUSIONS Compared with COIL, VEIL can effectively reduce postoperative wound complications and improve patients' cosmetic satisfaction and life quality without compromising therapeutic efficacy. Hence, we believe that VEIL is a good alternative to COIL for vulvar cancer patients when surgical expertise is available.
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Pouwer AFW, Arts HJ, van der Velden J, de Hullu JA. Limiting the morbidity of inguinofemoral lymphadenectomy in vulvar cancer patients; a review. Expert Rev Anticancer Ther 2017; 17:615-624. [PMID: 28608762 DOI: 10.1080/14737140.2017.1337513] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inguinofemoral lymphadenectomy (IFL) is performed in the treatment for vulvar cancer. One or more complications after IFL is reported in up to 85% of the patients. This review presents an overview of surgical techniques and peri- and post-operative care that has been studied in order to reduce the morbidity associated with IFL in vulvar cancer patients. Areas covered: Current knowledge on post-operative complications after different surgical techniques and peri- and post-operative protocols were discussed. A systematic literature review was conducted using MEDLINE, EMBASE and the Cochrane library on 20 February 2017. In order to be eligible for inclusion, studies must report the associated post-operative morbidity per surgical technique, or peri- or post-operative care given after IFL in vulvar cancer patients. Expert commentary: After the implementation of several new surgical techniques, the morbidity after IFL decreased but remains high and clinically meaningful. More research is needed on surgical techniques and peri-or post-operative care to further reduce the complication rates after IFL in vulvar cancer patients.
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Affiliation(s)
- Anne-Floor W Pouwer
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
| | - Henriette J Arts
- b Department of Obstetrics and Gynaecology , University Medical Center Groningen , Groningen , The Netherlands
| | - Jacobus van der Velden
- c Department of Obstetrics and Gynaecology , Center for Gynaecologic Oncology Amsterdam (location: Academic Medical Center) , Amsterdam , The Netherlands
| | - Joanne A de Hullu
- a Department of Obstetrics and Gynaecology , Radboud university medical center , Nijmegen , The Netherlands
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Abstract
The standard radical mutilating surgery for the treatment of invasive vulval carcinoma is, today, being replaced by a conservative and individualised approach. Surgical conservative modifications that are currently considered safe, regarding vulval lesion, are separate skin vulval-groin incisions, drawn according to the lesion diameter, and wide local radical excision or partial radical vulvectomy with 1-2 cm of clinically clear surgical margins. Regarding inguinofemoral lymph nodes management, surgical conservative modifications not compromising patient survival are omission of groin lymphadenectomy only when tumour stromal invasion is ≤ 1 mm, unilateral groin lymphadenectomy only in well-lateralised early lesions and total or radical inguinofemoral lymphadenectomy with preservation of femoral fascia when full groin resection is needed. Sentinel lymph node dissection is a promising technique but it should not be routinely employed outside referral centres. Pelvic nodes are better managed by radiation. Locally advanced vulval carcinoma can be managed by ultraradical surgery, exclusive radiotherapy or chemoradiation.
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Yao K, Zou Z, Li Z, Zhou F, Qin Z, Liu Z, Li Y, Han H. Fascia Lata Preservation During Inguinal Lymphadenectomy for Penile Cancer: Rationale and Outcome. Urology 2013; 82:642-7. [DOI: 10.1016/j.urology.2013.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/05/2013] [Accepted: 05/18/2013] [Indexed: 11/19/2022]
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van Beekhuizen HJ, van Doorn HC. Comment on: Does the number of nodes removed impact survival in vulvar cancer patients with node-negative disease? Madeleine Courtney-Brooks, Paniti Sukumvanich, Sushil Beriwal, Kristin K. Zorn, Scott D. Richard, Thomas C. Krivak. Gynecological Oncology 117 (2010) 308-311. Gynecol Oncol 2011; 120:160; author reply 160-1. [PMID: 21040951 DOI: 10.1016/j.ygyno.2010.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 09/28/2010] [Indexed: 11/24/2022]
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Heyns CF, Fleshner N, Sangar V, Schlenker B, Yuvaraja TB, van Poppel H. Management of the Lymph Nodes in Penile Cancer. Urology 2010; 76:S43-57. [DOI: 10.1016/j.urology.2010.03.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/01/2010] [Accepted: 03/01/2010] [Indexed: 02/05/2023]
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Yao K, Tu H, Li YH, Qin ZK, Liu ZW, Zhou FJ, Han H. Modified Technique of Radical Inguinal Lymphadenectomy for Penile Carcinoma: Morbidity and Outcome. J Urol 2010; 184:546-52. [DOI: 10.1016/j.juro.2010.03.140] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Kai Yao
- Department of Urology, Cancer Center, Sun Yat-Sen University and State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China
| | - Hua Tu
- Department of Urology, Cancer Center, Sun Yat-Sen University and State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China
| | - Yong-Hong Li
- Department of Urology, Cancer Center, Sun Yat-Sen University and State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China
| | - Zi-Ke Qin
- Department of Urology, Cancer Center, Sun Yat-Sen University and State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China
| | - Zhuo-Wei Liu
- Department of Urology, Cancer Center, Sun Yat-Sen University and State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China
| | - Fang-Jian Zhou
- Department of Urology, Cancer Center, Sun Yat-Sen University and State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China
| | - Hui Han
- Department of Urology, Cancer Center, Sun Yat-Sen University and State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China
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Abbas S, Seitz M. Systematic review and meta-analysis of the used surgical techniques to reduce leg lymphedema following radical inguinal nodes dissection. Surg Oncol 2009; 20:88-96. [PMID: 20005090 DOI: 10.1016/j.suronc.2009.11.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 11/14/2009] [Accepted: 11/16/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inguinal nodes dissection is associated with high rates of morbidity, lymphedema in particular is a chronic disabling condition which is a common complication following this operation. Prevention or minimization of this condition is an important aim when considering this procedure. Many technical modifications are suggested for this purpose. This systematic review aims at assessing the efficacy of the available strategies to reduce the risk and severity of leg lymphedema. METHODS For this review, MEDLINE and EMBASE were searched to identify studies that reported surgical strategies designed to reduce complications of groin dissection and in particular leg lymphedema. Studies that reported outcome of long saphenous vein sparing, fascia preserving dissection, microvascular surgery, sartorius transposition and omental pedicle flap were located. Data were collected using predefined inclusion and exclusion criteria. A combined odds ratio was calculated combining studies suitable for meta-analysis using the random effect model. RESULTS The search result defined few studies that reported results of saphenous vein sparing technique; some of those studies were found suitable for meta-analysis based on the Newcastle-Ottawa scale for non-randomized studies. The meta-analysis showed significant reduction of lymphedema (odds ratio 0.24, 95% CI 0.11-0.53) and other complications of inguinal node dissection. There were no randomized studies to address this problem; there are also isolated studies that reported benefits of other techniques but none of them was suitable for meta-analysis. CONCLUSION Meta-analysis of the reported studies on sparing the long saphenous vein in inguinal nodes dissection suggests a reduced rate of lymphedema and other postoperative complications. Other methods that may be beneficial are fascia preserving dissection, pedicled omental flap and microsurgery; however sartorius transposition has not been shown to reduce the rate of complications. Randomized controlled trials are needed to prove the benefits of various technical modifications.
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Affiliation(s)
- Saleh Abbas
- Hunter and New England Health Area, Manning Hospital, 26 YORK Street, Taree, NSW 2430, Australia.
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Manci N, Marchetti C, Esposito F, De Falco C, Bellati F, Giorgini M, Angioli R, Panici PB. Inguinofemoral Lymphadenectomy: Randomized Trial Comparing Inguinal Skin Access Above or Below the Inguinal Ligament. Ann Surg Oncol 2008; 16:721-8. [DOI: 10.1245/s10434-008-0216-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 07/30/2008] [Accepted: 10/01/2008] [Indexed: 11/18/2022]
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Abstract
The draining lymph nodes of extra-abdominal tumors and malignant lesions of the lower extremity are located in the groin and iliac region. Malignancies with lymphatic drainage into this region include tumors of the anorectum, penis and vulva, skin (melanoma, squamous cell carcinoma), and soft tissue sarcomas. Current clinical research in biology, routes of lymphatic spread, and the possibility of marking the sentinel lymph node has directed lymphadenectomy strategy toward differential procedures, depending on the type of underlying malignancy. The spectrum of lymphadenectomy includes diagnostic lymph node removal of clinically enlarged nodes, removal of the sentinel node, and radical lymphadenectomy. Lymphadenectomy can also be indicated as a palliative procedure. The indications also depend on the type of tumor, previous treatment, and disease prognosis. This review presents the current state of indications and surgical techniques of inguinal and iliacal lymphadenectomy.
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Affiliation(s)
- P M Vogt
- Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule, Carl-Neuberg-Strasse 1, 30625 Hannover.
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