Dipartimento Universitario Scienze della Vita e Sanità Pubblica - Sezione di Ginecologia ed Ostetricia - Università Cattolica del Sacro Cuore, Rome, Italy.
Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.
Int J Gynecol Cancer. 2022 Jul 4;32(7):846-852. doi: 10.1136/ijgc-2022-003347.
The goal of this study was to assess the feasibility and safety of a retrograde extraperitoneal trans-inguinal novel approach to pelvic lymphadenectomy in vulvar cancer patients. The secondary objectives were to assess complications (early and late) and oncological outcomes.
In this pilot study, all patients referred to our institution from November 2019 to May 2021 were evaluated. The inclusion criteria were patients diagnosed with primary/recurrent vulvar cancer and who were candidates for concomitant groin and pelvic lymph node dissection. A consecutive sampling was planned during the study period. After conventional inguino-femoral lymph nodal dissection, ipsilateral extraperitoneal trans-inguinal pelvic lymphadenectomy (TRIPLE) was performed through a groin incision. Clinical data, type of treatment, perioperative complications, and follow-up were evaluated.
13 patients (8 primary, 5 recurrent vulvar cancer) underwent 16 TRIPLE procedures (10 unilateral, 3 bilateral). The median age was 69 years (range 58-93 years); 8 patients had comorbidities (61.5%). Up front locoregional radiotherapy was previously performed in two cases (15.4%). The pathology report showed metastatic lymph nodes in 20 (87%) groins and 11 (68.8%) pelvic sites; the mean number of removed and metastatic pelvic lymph nodes was 12.1 (range 5-33) and 2.9 (range 0-18), respectively. No intra-operative site-specific complications occurred. One (5.9%) post-operative site-specific complication was reported (pelvic abscess, grade 2), which was treated with antibiotics. One patient died due to concomitant pneumonia. No unilateral pelvic lymph node recurrence occurred during follow-up (median 13 months, range 2-43 months); 3 patients (23.1%) had distant site recurrence (median disease-free survival 9 months).
TRIPLE seems to be a feasible and safe technique, providing adequate lymph node dissection. Despite being a high-risk and fragile population, morbidity was similar to previously reported data for conventional mini-invasive approaches. Prospective larger comparative series are necessary.
本研究旨在评估逆行经腹膜外经腹股沟新入路在外阴癌患者盆腔淋巴结清扫中的可行性和安全性。次要目标是评估并发症（早期和晚期）和肿瘤学结果。
在这项试点研究中，评估了 2019 年 11 月至 2021 年 5 月期间我院收治的所有患者。纳入标准为诊断为原发性/复发性外阴癌且适合同期腹股沟和盆腔淋巴结清扫的患者。在研究期间计划进行连续抽样。在完成常规腹股沟-股部淋巴结解剖后，通过腹股沟切口进行同侧腹膜外经腹股沟盆腔淋巴结清扫（TRIPLE）。评估临床数据、治疗类型、围手术期并发症和随访情况。
13 例患者（8 例原发性，5 例复发性外阴癌）接受了 16 次 TRIPLE 手术（10 例单侧，3 例双侧）。中位年龄为 69 岁（范围 58-93 岁）；8 例患者合并症（61.5%）。2 例（15.4%）患者在初次局部放疗前接受了治疗。病理报告显示 20 例（87%）腹股沟和 11 例（68.8%）盆腔部位有转移淋巴结；切除和转移的盆腔淋巴结平均数量分别为 12.1（范围 5-33）和 2.9（范围 0-18）。无术中特定部位并发症发生。报告了 1 例（5.9%）术后特定部位并发症（盆腔脓肿，2 级），用抗生素治疗。1 例患者因并发肺炎死亡。随访期间无单侧盆腔淋巴结复发（中位随访时间 13 个月，范围 2-43 个月）；3 例（23.1%）患者出现远处部位复发（中位无病生存期 9 个月）。
TRIPLE 似乎是一种可行且安全的技术，可提供充分的淋巴结清扫。尽管患者为高危和脆弱人群，但发病率与传统微创方法的报道数据相似。需要进行前瞻性、更大的对照系列研究。
