Complication rates and lymph node count between two different skin incisions at time of inguino-femoral lymph node dissection in vulvar cancer.

INTRODUCTION

Inguino-femoral lymph node dissection plays a crucial role in the management of vulvar cancer. The procedure is associated with high complication rates, including infection, lymphocysts/lymphoedema and wound dehiscence. Several skin incision techniques exist and practice among gynecology oncologists is variable. Little evidence exists to guide surgeons regarding the optimal surgical approach. This study aimed to determine the difference in 30-day complication rates, number of lymph nodes and length of stay between patients undergoing the modified oblique and classical 'lazy S' skin incision.

METHODS

A retrospective review between January 2014 and September 2018 was performed in the University Hospital of Wales, Cardiff. All cases of inguino-femoral lymph node dissection performed for vulvar cancer were included in the study without exclusion. Data collected included age, body mass index (BMI), incision type, suture material, length of hospital stay, complication rates, cancer stage, lymph node count, lymph node positivity rate and recurrence rates. Data were analyzed using SPSS software and clinical significance was set as p<0.05.

RESULTS

Thirty-five cases of classical 'lazy S' and 14 cases of modified oblique were included in the analysis. The mean patient age was 65 years (range 41-86) in the classical 'lazy S' group and 58 years (range 19-81) in the modified oblique group. The mean BMI was 28 kg/m (range 18-45) in the classical 'lazy S' group and 29 kg/m (range 20-36) in the modified oblique group. In the classical 'lazy S' group, the stage classification was as follows: stage IB (18), II (2), IIIA (3), IIIB (4), IIIC (8). In the modified oblique group, the stage classification was: stage IB (8), II (4), IIIA (2). Grade 3-4 complications were statistically significantly more common after the classical 'lazy S' versus the modified oblique operation (20/35, 57.1% vs 2/14, 14.3%, p<0.02). Mean number of nodes harvested was statistically significantly higher in the classical 'lazy S' group compared with the modified oblique group (11.1 nodes, range 6-17 vs 7 nodes, range 4-11, p<0.001). Node positivity rate was higher in the classical 'lazy S' group compared with the modified oblique group (28.6% vs 10%, p=0.08). Mean hospital stay was statistically significantly longer in patients undergoing classical 'lazy S' versus modified oblique (10.7 vs 4.5 days, p=0.02). One case of groin node recurrence occurred and this patient was in the classical 'lazy S' arm.

CONCLUSION

The rate of overall and serious complications was lower after modified oblique skin incision compared with classical 'lazy S'. However, the absolute lymph node count and lymph node positivity rate were higher in the 'lazy S' group.