Klapdor Rüdiger, Hertel Hermann, Soergel Philipp, Hillemanns Peter
Department of Obstetrics and Gynaecology, Hanover Medical School, Hannover, Germany.
Int J Gynecol Cancer. 2017 Jan;27(1):166-170. doi: 10.1097/IGC.0000000000000860.
This study aimed to evaluate the recurrence rates after sole sentinel dissection in vulvar cancer and describe characteristics of groin recurrences.
All vulvar cancer cases between 2008 and 2014 were reviewed. Inclusion criteria were restricted to lymph node-negative patients, sole sentinel lymph node dissection (SLND), and tumor diameter less than 4 cm. In all patients, Tc-99m nanocolloid was used for preoperative SLN imaging. Regularly, planar lymphoscintigraphy and single-photon emission computed tomography with computed tomography were performed. Ultrastaging was routinely conducted on all negative lymph nodes.
Of 140 vulvar cancer cases, 30 node-negative patients underwent sole SLND and met inclusion criteria. Keratinizing squamous cell carcinoma was determined in final histology in 20/30 (66.7%) patients and the mainly diagnosed tumor stage was pT1b (21/30, 70%). Three perioperative complications occurred. On average, 4.6 (1-9) SLNs were dissected per patient and 2.5 (1-6) per each groin, respectively. During a median follow-up of 43.5 (4-75) months, 5/30 (16.7%; 95% confidence interval, 7.3%-33.6%) local recurrences occurred. In addition, 2/30 (6.6%; 95% confidence interval, 1.9%-21.3%) groin recurrences were identified within a period of 12 months after the primary surgery. Both patients had large (>2 cm) midline tumors. Despite surgical as well as adjuvant treatment of the recurrent disease, both patients with groin recurrences died.
Sentinel lymph node dissection is a safe and feasible alternative in early vulvar cancer. But false-negative sentinel carry a high risk of mostly fatal groin recurrences. Especially, midline tumors larger than 2 cm have to be treated with caution, because they are mostly found in cases with groin recurrences after sole SLND.
本研究旨在评估外阴癌单纯前哨淋巴结清扫术后的复发率，并描述腹股沟复发的特征。
回顾了2008年至2014年间所有外阴癌病例。纳入标准仅限于淋巴结阴性患者、单纯前哨淋巴结清扫术（SLND）且肿瘤直径小于4 cm。所有患者术前均使用锝-99m纳米胶体进行前哨淋巴结显像。常规进行平面淋巴闪烁显像和单光子发射计算机断层扫描并结合计算机断层扫描。对所有阴性淋巴结常规进行超分期检查。
140例外阴癌病例中，30例淋巴结阴性患者接受了单纯SLND并符合纳入标准。最终组织学检查确定20/30（66.7%）例患者为角化性鳞状细胞癌，主要诊断的肿瘤分期为pT1b（21/30，70%）。发生了3例围手术期并发症。每位患者平均清扫4.6（1 - 9）枚前哨淋巴结，每个腹股沟平均清扫2.5（1 - 6）枚。在中位随访43.5（4 - 75）个月期间，发生了5/30（16.7%；95%置信区间，7.3% - 33.6%）例局部复发。此外，在初次手术后12个月内发现2/30（6.6%；95%置信区间，1.9% - 21.3%）例腹股沟复发。这两名患者均有较大（>2 cm）的中线肿瘤。尽管对复发病例进行了手术及辅助治疗，但两名腹股沟复发患者均死亡。
前哨淋巴结清扫术是早期外阴癌一种安全可行的替代方法。但假阴性前哨淋巴结有很高的风险导致大多致命的腹股沟复发。特别是，大于2 cm的中线肿瘤必须谨慎处理，因为它们大多出现在单纯SLND术后腹股沟复发的病例中。
