Evaluation of nodal involvement in squamous cell carcinoma of the vulva and therapeutic implications (author's transl)

Abstract

152 cases of squamous cell carcinoma of the vulva, operated at the National Cancer Institute of Milan have been analyzed for the purpose of assessing: the frequency of metastases in relation to the. local extent, site of the growth, and clinical and lymphography diagnosis. We reached the following conclusions: a) in T1N0 cancers, the incidence of inguinal metastases is less than 2.7 %. Therefore in unilateral T1N0 tumors a simple vulvectomy may be considered; b) in median tumors, metastases are always bilateral, and in the mixed ones (lateral and median) bilateral metastases are more frequent than unilateral metastases (31.4% vs. 12.9%); c) in unilateral tumors, inguinal metastases are homolateral or bilateral: we have never observed inguinal metastases contralateral to the primary growth. We think that inguinal lymphadenectomy should be bilateral in median or mixed tumors, while in unilateral cases it should be bilateral only in cases where at least homolateral metastases are present. We have never observed pelvic metastases in patients with negative pelvic lymphangiography and/or without inguinal metastatic nodes. Pelvic lymphadenectomy should be planned only in cases of metastases of ipsilateral inguinal nodes or if there are lymphographically positive nodes. We think that the surgical approach to cancer of the vulva should be planned taking into account the T, the N, and the Iymphographic or histologic peroperative diagnosis. In this way, radicality and, at the same time, saving of non-metastatic nodes, which can play an important role in preventing recurrences, could be achieved.