Use of the Sentinel Lymph Node Technique Compared to Complete Inguino-femoral Lymph Node Removal in Patients with Invasive Vulvar Cancer in Germany
2013
In the current S2 guidelines, the standard surgical therapy for patients with
vulvar cancer also includes inguino-femoral lymphadenectomy. However, in
view of the severe side-effects associated with this approach such as
problems with wound healing, lymphoceles and lymphoedema, the search is on
for alternative treatments that could decrease treatment-associated
morbidity and improve patientsʼ quality of life, particularly for
node-negative patients. The sentinel lymph node technique is currently the
gold standard in the treatment of unifocal breast cancer (clinically
negative axilla), and studies on the use of this technique in the treatment
of vulvar cancer are promising. To date, the diagnostic accuracy of this
method in vulvar cancer has only been evaluated in a single, one-arm,
non-randomised, multicentre study. In preparation for a multicentre study,
in 2010 we surveyed 41 German hospitals to investigate how often they used
the sentinel lymph node technique compared to inguino-femoral
lymphadenectomy. The hospitals were grouped according to hospital size and
number of patients treated for vulvar cancer. The decision criteria to
determine the type of procedure performed were also investigated. Finally,
the hospitals were asked whether they would be willing to participate in a
prospective clinical study to evaluate the sentinel lymph node technique in
patients with vulvar cancer. The majority of surgeons questioned (73 %)
already had some experience with this technique in patients with vulvar
cancer. In our survey, 27 % of hospitals carried out inguino-femoral
lymphadenectomy, 10 % used the sentinel lymph node technique, and 63 % used
both methods. In 24 % of hospitals, the standard procedure consisted of the
sentinel lymph node technique supplemented by inguino-femoral
lymphadenectomy. Only 20 % of the institutions surveyed in our study carried
out sentinel lymph node biopsy alone in accordance with the criteria of the
consensus recommendations. The majority of the investigated institutions
were willing to participate in a randomised prospective clinical study to
evaluate the effectiveness of sentinel lymph node sampling in patients with
vulvar cancer.
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