349 Management of sentinel node procedure in vulvar cancer in Germany: a survey among gynecological departments

Introduction/Background* Lymph node involvement is the most important prognostic factor for recurrence and survival in vulvar cancer. Sentinel lymphonodectomy (SNLD) successfully replaced inguinofemoral lymphadenectomy (IL) in patients with early vulvar cancer. Nevertheless, management of patients in special situations is not well studied or current data are inconclusive. Methodology To assess the current management of diagnostic and surgical procedures with respect to SNLD in early vulvar cancer, a web-based survey was mailed to 612 gynecological departments. Data are presented as frequencies of selected items. Result(s)* A total of 222 hospitals (36.27%) replied the questionnaire. Only 9.5% of hospitals did not offer the SNLD and 79.5% processed the evaluation of sentinel node (SN) by ultrastaging. After detection of isolated tumor cells (ITCs) or micrometastases, IL was performed in 28.1% and 60.5% of hospitals, respectively, and radiation without further surgical intervention was performed in 19.3% and 23.8% of hospitals, respectively. In 50.9% and 15.1% of cases, hospitals would not initiate any further therapy in patients with ITCs and micrometastases, respectively. In vulvar cancer of the midline with unilateral localized positive SN, 49.1% and 48.6% of hospitals performed ipsilateral or bilateral IF, respectively. Repeat SNLD was performed by 16.2% of hospitals. Conclusion* The vast majority of German hospitals are following current guidelines and are offering SNLD in patients with early vulvar cancer. Despite the fact that according to the GROINSS-V-I-study approximately 42% of positive SN were determined by ultrastaging, only 79.5% of German hospitals implemented this procedure. Our findings showed that hospitals would recommend expectant management in patients with ITCs or with micrometastases in 50.9% and 15.1% of cases, but current guidelines do not support this approach. Nevertheless, radiation is a good option in these patients, as shown by preliminary results of the GROINSS-V-II-study. Bilateral IL should be performed in patients with unilateral positive SN, as a SN positivity rate of 22.2% on the contralateral side was described by a current study and understaging of the groins might be fatal. Any deviation from current guidelines, as well as applying the SNLD in special situations, should be individually discussed with each patient.