Abstract
PurposeEvaluating the counseling of patients with vulvar cancer in outpatient setting regarding the application of sentinel lymph node dissection (SLND), the selection of hospitals for further treatment, and level of knowledge.MethodsA questionnaire containing 29 questions about SLND in vulvar cancer was sent to gynecologists in Lower Saxony. The questionnaire contained multiple choice questions and open questions. The study was approved by the local ethics committee.ResultsThe median age of the 86 respondents was 54 (26–66) years. Most participants (83.1%) reported to only treat one to five patients with vulvar cancer per year. Interestingly, 70.5% of the gynecologists send their patients to university hospitals and 64.1% to hospitals offering maximum care, respectively. Of all, 32.7% replied that SLND was performed rarely or never in their patients. The gynecologists answered that only 36.7% of the patients are well informed about advantages and possible disadvantages of SLND. Most (84%) felt responsible to counsel patients on treatment decisions independently from or additionally to the hospital. Of all, 72% replied that they are not completely sure about the exact recurrence rates after SLND. Of notice, 66% believe that SLND for vulvar cancer is safe if applied in specialized centers and 92% stated that focusing treatment on specialized centers is required for best results.ConclusionSLND for vulvar cancer is widely accepted and regularly recommended among gynecologists. Outpatient doctors report to send most patients to specialized centers. However, it appears that patients remain uninformed after counseling in the clinics and that there is a lack of detailed knowledge about risks and complication rates of groin treatment in the outpatient setting.
Highlights
The clinical relevance of vulvar cancer grows because of its increasing incidence [1]
A questionnaire containing 29 questions about sentinel lymph node dissection (SLND) for vulvar cancer was sent to gynecologists (300) working in outpatient setting in Lower Saxony, Germany
More than 90% of the participants recommend a centralization regarding the treatment of vulvar cancer patients in specialized centers (Fig. 1b)
Summary
The clinical relevance of vulvar cancer grows because of its increasing incidence [1]. For patients with vulvar cancer affection of lymph node metastases represents the most. To prevent overtreatment in early-stage vulvar cancer, sentinel lymph node dissection (SLND) has been established as an alternative to radical LND, especially because of its significantly lower morbidity [5, 6]. In the GROINSS-V-I study, a prospective observational study, SLND led to low groin recurrence rates (2.3%) and low morbidity, if applied. Multiple retrospective studies have been performed showing mixed results with groin recurrence rates for SLND ranging between 0 and 12% [7]. According to a large metaanalysis comparing LND with SLND, groin recurrence rates appeared to be similar only under optimal conditions (unifocal tumors < 4 cm, clinically non-suspicious nodes in the groin, specific infrastructure, human resource, appropriate techniques, and procedures) [7]
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