Pape O, Lopès P, Bouquin R, Evrard S, Ansquer C, Laboisse C, Philippe H-J
Service de gynécologie-obstétrique, hôpital de la Mère-et-de-l'Enfant, CHU de Nantes, 7, quai Moncousu, 44093 Nantes cedex 01, France.
Gynecol Obstet Fertil. 2006 Dec;34(12):1105-10. doi: 10.1016/j.gyobfe.2006.10.009. Epub 2006 Nov 13.
Vulvar cancer represents approximately 4% of all gynecologic malignancies and the most important prognosis factor in this cancer is the status of the regional lymph nodes. The radical inguinal lymphadenectomy, associated or not with radiotherapy, is accompanied by high morbidity, which can affect 50% of the patients. The sentinel node detection appears now to be feasible in patients with vulvar carcinoma, in order to reduce the morbidity of inguinal lymphadenectomy. But contrary to breast cancer, the learning curve is not easy to obtain because of the low number of cases. That is why we have described the procedure of selective lymphadenectomy. The aim of this technique is to remove the blue and/or marked inguinal lymph node and any other palpable lymph node, without a real radical inguinal lymphadenectomy. Thus, since November 2003, 4 procedures have been performed in total. With the lymphoscintigraphy, we identified 17 marked lymph node and we finally obtained 28 lymph nodes after surgery, with only one metastatic lymph node. There was no complication after our procedure. Selective lymphadenectomy appears to be a new procedure which may reduce the morbidity of usual inguinal lymphadenectomy.
外阴癌约占所有妇科恶性肿瘤的4%，该癌症最重要的预后因素是区域淋巴结的状况。根治性腹股沟淋巴结清扫术，无论是否联合放疗，都会伴随着高发病率，可能影响50%的患者。目前，前哨淋巴结检测对外阴癌患者似乎是可行的，以降低腹股沟淋巴结清扫术的发病率。但与乳腺癌不同，由于病例数量少，学习曲线不易获得。这就是我们描述选择性淋巴结清扫术的原因。该技术的目的是切除蓝色和/或标记的腹股沟淋巴结以及任何其他可触及的淋巴结，而不进行真正的根治性腹股沟淋巴结清扫术。因此，自2003年11月以来，总共进行了4例手术。通过淋巴闪烁造影，我们识别出17个标记淋巴结，术后最终获得28个淋巴结，其中只有一个转移淋巴结。我们的手术没有并发症。选择性淋巴结清扫术似乎是一种新的手术方法，可能会降低常规腹股沟淋巴结清扫术的发病率。
