Does the count after inguinofemoral lymphadenectomy in vulvar cancer correlate with outcome?

Abstract

BackgroundInguinal lymph node (LN) metastasis is an important prognostic factor in vulvar cancer. Our aim was to determine the prognostic value of the number of resected LNs in inguinofemoral lymphadenectomy. MethodsA retrospective analysis was performed in a series of 158 individuals who underwent bilateral inguinofemoral lymphadenectomy for vulvar squamous cell carcinoma from January 1980 to February 2010. ResultsThe mean age was 67 years (range: 15–90). Median tumor size was 5cm (range: 1–18). A median of 22.5 inguinal LNs (range: 2–57) was resected. Thirteen (8.2%) patients had <12 LNs resected, and 145 (91.8%) had ≥12 LNs resected. Eighty (50.6%) patients had LN metastasis, with a median of 2 positive LNs (range: 1–16). Of those with positive LNs, 19 (23.8%), 23 (28.8%), and 38 (47.5%) patients had 1, 2, and 3 or more positive LNs, respectively. Thirty-three (41.2%) patients had bilateral LN metastasis. For patients without LN involvement, we failed to observe any significant difference between patients with <12 LNs and ≥12 LNs that were resected with regard to risk of recurrence (p=0.97) and death from cancer (p=0.43) in 5 years. However, resection of <12 LNs in patients with positive LNs negatively impacted the risk of recurrence (p=0.003) and death from cancer (p=0.043). ConclusionsResection of fewer than 12 LNs in vulvar cancer has a negative impact on outcome for patients with positive inguinal LNs.