Letters to the Editor
To the Editor
The surgical treatment of vulval cancer has changed dramatically for the last 5 years. The changes in management are all based on the lymph node status. In 2008, a benchmark study was published showing that in early stage, not central vulval cancer only a sentinel node could be performed.1 A recent study showed that also in central tumors only a sentinel node could be removed.2 If the sentinel node was not involved by metastatic disease, a bilateral inguinofemoral lymphadenectomy can be abandoned. This approach will lead to considerable morbidity reduction (wound infection, wound dehiscence, lymphocyst formation, and lymphedema) and a shorter hospital stay, with subsequently as serious decrease in resource costs.
Because of the introduction of sentinel node, we will enter a new era for recurrent vulval cancer patients. In case of local recurrence, the policy is to excise the lesion with a margin of minimal 1-cm normal tissue, and there is no place for groin surgery if on clinical examination and imaging there are no signs of distant disease. However, if there is a local recurrence, there is also the possibility of spread to lymph nodes. If previously only a sentinel has been removed, one should consider repeating the sentinel node procedure. In a few cases, one will find involved lymph node in the groin or pelvis, and this will alter the management for these patients. It is our experience that the technique is feasible and has a low morbidity. Based on the therapeutic consequences, we would recommend to perform a sentinel node in all cases of a local vulval cancer recurrence.
WiebrenAge Andries Tjalma,MD,PhD
Multidisciplinary Breast and Gynecologic
Oncology Clinic, Antwerp University
Hospital, University of Antwerp
1. van der Zee AG, Oonk MH, de Hullu JA, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008; 20: 884–889.
2. Coleman RL, Ali S, Levenback CF, et al. Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from Gynecologic Oncology Group (GOG) 173. Gynecol Oncol. 2013; 128: 155–159.