Groin Recurrence Rate Research Articles

Surgical unit volume and reoperation for recurrence following total extraperitoneal groin hernia repairs: nationwide population-based register study.

The quality of total extraperitoneal groin hernia repair and recurrence rates are influenced by various factors, potentially including the annual surgical unit volume of repairs. The precise nature of this relationship remains unclear. The aim of this study was to investigate the influence of surgical unit volume on reoperation rates for recurrence following total extraperitoneal groin hernia repair. This observational nationwide population-based study utilized prospectively collected data from the Swedish Hernia Register. Patients aged 15 years old or older who underwent a total extraperitoneal groin hernia repair from 1 January 2015 to 31 August 2019 were eligible. Follow-up time was until 31 August 2022. Surgical units were grouped into low-volume (fewer than 12 repairs per year), low-medium-volume (12-50 repairs per year), medium-high-volume (greater than 50-150 repairs per year), and high-volume (greater than 150 repairs per year) units. The primary outcome was reoperation for recurrence. The secondary outcome was postoperative complications. A total of 20 656 elective total extraperitoneal groin hernia repairs were included across 75 surgical units. The reoperation rate for recurrence was higher in all three lower-volume groups (low-volume, 5.3%; low-medium-volume, 3.8%; and medium-high-volume, 3.5%) compared with the high-volume group (2.9%). Adjusted multivariable Cox regression analysis revealed a statistically significant increased HR for reoperation for recurrence in the low-volume group (1.87 (95% c.i. 1.31 to 2.67)) and the low-medium-volume group (1.32 (95% c.i. 1.07 to 1.62)) compared with the high-volume group. No difference was seen between the groups regarding the risk of postoperative complications. The risk of reoperation for recurrence following total extraperitoneal groin hernia repair is significantly increased in surgical units that perform fewer than 51 repairs per year. The findings may influence guidelines on required annual surgical unit volume to improve patient outcomes following total extraperitoneal groin hernia repair.

Lymphatic mapping and sentinel node biopsy in vulvar melanoma: the first multicenter study and systematic review

Objective. This multicenter study aimed to investigate the role of preoperative lymphatic mapping and sentinel node biopsy (SNB) as well as the impact of negative SNB on loco-regional control and survival in vulvar melanoma patients with clinically negative nodes (cN0).Methods. Patients who had a proven vulvar melanoma with a Breslow thickness of 1–4 mm, cN0 and underwent a preoperative lymphatic mapping followed by SNB between July 2013 and March 2021 were retrospectively included. Groin recurrence and mortality rate were calculated as absolute and relative frequency. Disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan-Meier method. We provided a systematic review, searching among PubMed/Medline and Embase libraries. A total of 6 studies were identified (48 patients).Results. A total of 18 women were included. Preoperative planar images showed 51 SNs in 28 groins. Additional SPECT/CT images were acquired in 5/18 cases; SNs were identified pre- and intra-operatively in all cases. A total of 65 SNs were excised from 28 groins. A total of 13/18 (72.2%) patients (21/28 groins, 75%) had negative SNs with no groin recurrences and 12/13 (92.3%) were still alive at last follow-up. Five out of the 18 (27.8%) patients (7/28 groins, 25%) had positive SNs, 2/5 (40%) patients died of cancer after 26.2 and 33.8 months, respectively. The median DFS and OS for the entire cohort were 17.9 months (95% CI, 10.3–19.9) and 65.0 months (95% CI, 26.2-infinite), respectively. The probability of DFS and OS at 3 years were 15.5% (95% CI, 2.6–38.7) and 64.3% (95% CI, 15.5–90.2), respectively.Conclusions. The use of preoperative lymphatic mapping followed by SNB permits a precise and minimally invasive surgical approach in cN0 vulvar melanoma patients. Negative SNB is associated with low risk of groin relapse and good survival.

Feasibility and Efficacy of Desarda vs Lichtenstein Hernioplasty by Local Anesthesia for Inguinal Hernia Repair: A Noninferiority Randomized Clinical Trial

Introduction: Lichtenstein repair is a standard open technique for inguinal hernia but needs a prosthesis, increasing cost and complication. Conversely, Desarda autologous tissue repair is reported to have comparable results. This study aims to compare the efficacy of Desarda repair (DR) with Lichtenstein’s hernioplasty (LH) and establish the feasibility of operation under local anaesthesia (LA). Methods: This study was a prospective, double-blinded, non-inferiority randomized trial in patients undergoing open inguinal hernia repair under LA [NCT03512366]. The non-inferiority margin fixed was 0.5 days. The primary endpoint was time to return to the normal gait with comfort postoperative. The secondary endpoints studied were the incidence of surgical site occurrences (SSO), including recurrence. Results: The cohort comprised 56 patients (50.9%) in the DR group and 54 patients (49.1%) in the LH group. All the procedures were safely performed under LA. By intention-to-treat analysis, the median (interquartile range) duration for resuming gait post-surgery with comfort was 5 (interquartile range [IQR], 3-8) days in the DR vs 4 (IQR, 3-7) days in the LH arm (P = 0.16), thereby failing to demonstrate the noninferiority. There was no significant difference in days to return to work, surgical site occurrences, chronic groin pain, and two years recurrence rates. Conclusion: This study could not statistically prove the noninferiority of Desarda repair compared with Lichtenstein hernioplasty for resuming normal gait. Still, comparing the days to return to work, pain score, chronic groin pain and recurrence rate, Desarda repair faired equally with Lichtenstein hernioplasty, thereby highlighting its feasibility under local anaesthesia and efficacy.

Trial in progress: Phase II activity trial of high-dose radiation and chemosensitization in patients with macrometastatic lymph node spread after sentinel node biopsy in vulvar cancer: Groningen International Study on Sentinel Nodes in Vulvar Cancer III (GROINSS-V III/NRG-GY024).

TPS5624 Background: Early stage invasive squamous cell carcinoma of the vulva is treated by radical excision of the primary tumor combined with a sentinel node (SN) procedure for the groins. GROINSS-VI and GOG-173 demonstrated that if there is no metastasis to the SN, then standard of care is observation. GROINSS-VII/GOG-270 demonstrated that micrometastatic disease (<2mm) to the SN requires standard radiotherapy (50 Gy) without the need for an inguinofemoral lymphadenectomy (IFL). This study also found that patients with macrometastasis ( > 2mm) required IFL in order to have an acceptably low groin recurrence rate. However, IFL is associated with significant morbidity such as lymphedema, wound healing issues, and recurrent infections. It is hypothesized that for those with macrometastasis ( > 2 mm) in the SN, the efficacy of treatment can be increased by giving a higher dose of radiotherapy along with chemosensitization. Methods: This is an international multicenter single-arm phase II prospective clinical trial. The primary objective is to investigate the safety of replacing IFL by chemoradiation in early-stage vulvar cancer patients with a macrometastasis ( > 2mm) and/or extracapsular extension in the SN. The primary endpoint is the groin recurrence rate in the first two years after primary treatment. Secondary endpoints are short and long-term morbidity associated with the SN procedure and chemoradiation and quality of life as measured by EORTC-QLQc30. Patients with invasive ( > 1mm) squamous cell carcinoma of the vulva, stage T1, tumor size < 4 cm diameter and no suspicious lymph nodes by imaging of the groins will proceed with SN detection. Institutions enrolling patients must demonstrate prior surgical experience with SN detection with the submission of at least 10 successfully completed cases in vulvar cancer. Patients with SN metastases > 2mm and/or with extracapsular extension or those with > 1 SN with micrometastases will be eligible for this study. Treatment will consist of chemoradiation with a dose of 56 Gy to the groin combined with weekly cisplatin 40 mg/m2 IV on days 1, 8, 15, 21 and 29 of radiotherapy. One hundred and fifty-seven patients in Europe, United States and Canada will be enrolled. The study includes continuous monitoring of groin recurrences with stopping rules. Results of this trial may be practice changing and eliminate the need for IFL in all women with clinically early stage vulvar cancer. The study is currently open for enrollment. Clinical trial information: NCT05076942.

History and Updates of the GROINSS-V Studies.

Simple SummarySurgical management of vulvar cancer is associated with high morbidity rates. The main aim of the GROINSS-V studies is reducing treatment-related morbidity by finding safe alternative treatment options in patients with early-stage vulvar cancer. This article reviews the history, results, and updates of the GROINSS-V studies.Surgical management of vulvar cancer is associated with high morbidity rates. The main aim of the GROINSS-V studies is reducing treatment-related morbidity by finding safe alternative treatment options in early-stage vulvar cancer patients. This article reviews the history, results, and updates of the GROINSS-V studies. The first GROINSS-V study was a multicenter observational study (from 2000 to 2006), which investigated the safety and clinical applicability of the sentinel lymph node procedure in patients with early-stage vulvar cancer. GROINSS-V-I showed that omitting inguinofemoral lymphadenectomy was safe in early-stage vulvar cancer patients with a negative sentinel lymph node, with an impressive reduction in treatment-related morbidity. GROINSS-V-II, a prospective multicenter phase II single-arm treatment trial (from 2005 to 2016) investigated whether radiotherapy could be a safe alternative for inguinofemoral lymphadenectomy in patients with a metastatic sentinel lymph node. This study showed that radiotherapy in patients with sentinel lymph node micrometastases (≤2 mm) was safe in terms of groin recurrence rate and with less treatment-related morbidity. These results, published in August 2021, should be implemented in (inter)national treatment guidelines for vulvar cancer. GROINSS-V-III recently started including patients. This study investigates the effectiveness and safety of chemoradiation in patients with a macrometastasis (>2 mm) in the sentinel lymph node.

Radiotherapy is not indicated in patients with vulvar squamous cell carcinoma and only one occult intracapsular groin node metastasis

ObjectiveMost guidelines advise no adjuvant radiotherapy in vulvar squamous cell carcinoma and a single occult intracapsular lymph node metastasis. However, several recent studies have questioned the validity of this recommendation. The aim of this study was to analyze the groin recurrence rate in patients with a single intracapsular positive lymph node treated without adjuvant radiotherapy. MethodsPatients with a single clinically occult intracapsular lymph node metastasis, treated without adjuvant radiotherapy, formed the basis for this study. Groin recurrences, and the risk of death, were analyzed in relation to the size of the metastasis in the lymph node and the lymph node ratio. Data were analyzed using SPSS, version 26.0 for Windows. ResultsAfter a median follow-up of 64 months, one of 96 patients (1%) was diagnosed with an isolated groin recurrence and another two (2.1%) were diagnosed with a combination of a local and a groin recurrence. The only isolated groin recurrence occurred in a contralateral lymph node negative groin. Size of the metastasis and lymph node ratio had no impact on the groin recurrence risk, nor on survival. The 5-year actuarial disease-specific and overall survivals were 79% and 62.5% respectively. The 5-year actuarial groin recurrence-free survival was 97%. ConclusionBecause of the low risk of groin recurrence and the excellent groin recurrence-free survival, we recommend that adjuvant radiotherapy to the groin in patients with vulvar squamous cell carcinoma and a single occult intracapsular lymph node metastasis can be safely omitted to prevent unnecessary toxicity and morbidity.

Validation of sentinel lymph biopsy in patients with early stage vulvar cancer: A prospective trial of 1552 women (GROINSS-V II/GOG270)

Objective: The sentinel lymph node (SLN) procedure in vulvar cancer has become standard of care since our first GROINSS-V study reported a groin recurrence rate of 2.3%. In GROINSS-V II/GOG270, a study that investigated the safety of radiotherapy in patients with metastases in their SLN, all SLN-negative patients were registered in order to confirm our previous findings. Here we present the analysis of the patients with a negative SLN.

The role of the sentinel lymph node in vulvar cancer.

The aim of this study was to update clinical practice applications and technical procedures regarding sentinel lymph node (SLN) biopsy in vulvar cancer considering European experts' opinions from this field. Systematic data search performed using PubMed/medline database up to May 20, 2020. Focus was only for English language publications of original studies on SLN biopsy in vulvar cancer. Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. In early-stage vulvar cancer patients with a negative sentinel node the groin recurrence rate is low, survival is excellent, and treatment-related morbidity is minimal. We advise that sentinel node dissection, performed by a quality-controlled multidisciplinary team, should be part of the standard treatment in selected patients with early-stage vulvar cancer.

Evolution and outcomes of sentinel lymph node mapping in vulvar cancer

ObjectivesTo characterize our institutional experience with sentinel lymph node (SLN) biopsy in patients with vulvar cancer. We describe the oncologic outcomes of these patients and the utilization of SLN detection...

Lymphoscintigraphy and sentinel lymph node biopsy in vulvar carcinoma: update from a European expert panel.

This study aimed to update the clinical practice applications and technical procedures of sentinel lymph node (SLN) biopsy in vulvar cancer from European experts. A systematic data search using PubMed/MEDLINE database was performed up to May 29, 2019. Only original studies focused on SLN biopsy in vulvar cancer, published in the English language and with a minimum of nine patients were selected. Among 280 citations, 65 studies fulfilled the inclusion criteria. On the basis of the published evidences and consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. SLN biopsy is nowadays the standard treatment for well-selected women with clinically negative lymph nodes. Negative SLN is associated with a low groin recurrence rate and a good 5-year disease-specific survival rate. SLN biopsy is the most cost-effective approach than lymphadenectomy in early-stage vulvar cancer. However, future trials should focus on the safe extension of the indication of SLN biopsy in vulvar cancer. Although radiotracers and optical agents are widely used in the clinical routine, there is an increasing interest for hybrid tracers like indocyanine-99mTc-nanocolloid. Finally, it is essential to standardise the acquisition protocol including SPECT/CT images, and due to the low incidence of this type of malignancy to centralise this procedure in experienced centres for personalised approach.

Recurrence and survival rates in node negative patients after sentinel node biopsy for early-stage vulva cancer – A nationwide study

ObjectiveThe sentinel node (SN) procedure is adopted in selected patients with early-stage vulva cancer (VC) in Denmark. Due to the low incidence of VC, large population-based studies on the safety of SN outside multicenter clinical trials are lacking. The current study evaluated the risk of recurrence and survival in SN- negative VC patients. MethodsNationwide data was collected and registered prospectively in the Danish Gynecologic Cancer Database from January 2011 to July 2017. Patients with clinically stage IB-II unifocal vulva squamous cell carcinoma, tumor <4 cm and no clinically suspicious groin nodes or distant metastases, who underwent SN-procedure, were included. ResultsThe SN-procedure was performed in 286 patients, of these 190 (66.4%) patients were SN-negative. Twenty-three of the 190 SN-negative patients (12.1%) had one or more recurrences during a median follow-up of 30 months (range 1–83). Four patients (2.1%) had an isolated groin recurrence identified from 5 to 17 months after primary surgery. Fourteen patients (7.4%) experienced a local recurrence in vulva, 1 patient (0.5%) had a recurrence in the vulva and the groin and 4 patients (2.1%) had distant recurrences. The 3-year overall (OS) and disease-specific survival (DSS) for SN-negative patients was 84% and 93%, respectively. The 3-year OS for patients with recurrent disease was 58%. ConclusionsThis is the largest prospective nationwide study on SN-procedure in vulva cancer. The study confirms the safety of the SN-procedure in selected early-stage VC patients with a low isolated groin recurrence rate and a good DSS.

Audit of Patient Outcomes after Lichtenstein Hernioplasty for the Repair of Adult Inguinal Hernia

Background: Inguinal hernia repair is one of the most commonly performed surgeries worldwide. While numerous surgical approaches exist to treat inguinal hernias, the Lichtenstein tension-free mesh repair remains the gold standard. This retrospective study is carried out to evaluate the short and long term outcomes of Lichtenstein hernioplasty in the hand of a general surgeon. Patients and Methods: A retrospective analysis of all adult inguinal hernia repair by Lichtenstein method between January .2003 and December 2009 was carried out. The outcome measures were early post-operative complications, incidence of chronic groin pain and recurrence rate. Results: A total of 526 procedures were carried out in 445 adult male patients during the study period. The median age of the patients was 49 years (range, 21-73 years). All patients underwent Lichtenstein hernioplasty under spinal anesthesia. Length of hospital stay was median 2.4 days (range, 1-4 days). Median time to the resumption of normal activities was 8 days (range, 5-1 0 days). Urinary retention was the most frequent early post-operative complication (5.1 6%). Rate of wound infection was acceptable (0.44%). Chronic groin pain was experienced by three patients (0.67%). There was no recurrence observed among the 291 (65.4% of the total) patients who were available after two years of the procedure. Conclusion: The Lichtenstein open tension-free mesh repair of adult inguinal hernia is a safe procedure with least post-operative morbidity and least chance for recurrence. It is a simple technique, quick and. easy to perform without compromising the patient's care and long-term outcome in the hand of an experienced general surgeon.&#x0D; Journal of Surgical Sciences (2012) Vol. 16 (2) : 54-58

The efficacy of absorbable versus non-absorbable fixation in laparoscopic totally extraperitoneal (tep) repair of large inguinal hernias

Our study aims to compare clinical outcomes of laparoscopic Totally Extra-peritoneal (TEP) repair with mesh fixation in large inguinal hernias using titanium versus absorbable tacks. This is a case control study of patients who underwent laparoscopic TEP repair with mesh fixation of large inguinal hernias in our institution from 2010 to 2015. In all patients a standard 10×15cm large-pore polypropylene mesh was used and a standardized fixation technique was followed. Patient demographics, presentation, defect size as per the European Hernia Society Groin Hernia Classification, post-operative complications and recurrence rates were collected and analysed. 20 patients had mesh fixation with titanium tackers (Group TT) were compared with 37 patients who had mesh fixation with absorbable tacks (Group AT). Mean age was 57.00 (±13.78) in Group TT and 49.00 (±17.15) in Group AT. All patients were males. The median defect size was L3M2 in Group TT and L2M2 in Group AT. All patients were followed up for a mean period of 24 months (range: 1-48 months). Post-operatively, one patient in Group AT developed chronic pain. One Group TT patient and four Group AT patients developed seromas, which were treated conservatively. There were no recurrences in Group TT, while one Group AT patient developed a medial recurrence. Both titanium and absorbable tacks showed similar post-operative complications and pain scores. As such, they both appear safe and feasible for mesh fixation during laparoscopic repair of large inguinal hernias.

Sentinel lymph nodes in vulvar cancer: Management dilemmas in patients with positive nodes and larger tumors

BackgroundAlthough sentinel lymph node (SLN) biopsy has been routinely used in the treatment of invasive squamous cell carcinoma (SCC), questions still remain regarding the management of patients with positive nodes, as well as its use in patients with larger tumors. MethodsRetrospective study of all patients at a single institution with primary vulvar cancer who had SLN biopsy (2008–2015). Patient and tumor characteristics were collected from hospital records. For patients with positive SLN and for those with tumors ≥40 mm, recurrence rates and location were specifically recorded. ResultsSLN biopsy was successful in 159 patients (245 groins). Median follow-up was 31 months.120 patients (187 groins) had a negative SLN without an inguinofemoral lymph node dissection (IFL); there were 6 ipsilateral groin recurrences (5%).7 patients had micrometastasis (≤2 mm) in the SLN and were treated by radiotherapy. There were no recurrences in the irradiated groins.19 patients with a positive unilateral SLN had bilateral IFL. One (5.3%) had a positive node in the contralateral groin. 9 patients with positive unilateral SLN had subsequent ipsilateral IFL; there were no groin recurrences in the contralateral groin.20 patients had tumor size ≥40 mm. 11 patients had a negative SLN biopsy, and thus no IFL; of these patients, 1 had an isolated groin recurrence (9%). ConclusionThese data suggest it is reasonable to omit a full groin dissection for micrometastatic disease in the SLN, and to perform a unilateral groin dissection in patients with unilateral SLN metastasis. SLN alone in larger tumors may have a higher groin recurrence rate.

Groin Pain Characteristics and Recurrence Rates: Three-year Results of a Randomized Controlled Trial Comparing Self-gripping Progrip Mesh and Sutured Polypropylene Mesh for Open Inguinal Hernia Repair.

The aim of this study was to investigate long-term groin pain and inguinal hernia recurrence rates of 2 types of mesh and to describe the evolution of postoperative groin sensory disturbances. Some patients with an inguinal hernia develop chronic pain following open mesh insertion. Previous trials comparing a semi-resorbable, self-gripping Progrip mesh with a standard sutured polypropylene mesh found conflicting results regarding recurrence rates and residual groin pain. Patients aged >18 years scheduled for open primary hernia repair were randomized to a self-gripping mesh (Progrip) or a polypropylene mesh (standard). Removal of the inguinal nerves was left to the discretion of the surgeon. Pain was measured using Visual Analogue Scale (VAS) over a 3-year period. Pain characteristics and hernia recurrences were determined using physical examination. Data of 274 patients were complete (75% three-year follow-up rate). Pain steadily decreased over time in both groups in a similar fashion (moderate pain 3.7% in each group). Hyperesthesia was experienced by 2.2% and 3.7% and hypoesthesia in 12% and 19% in Progrip and standard group, respectively. One of seven Progrip patients reported a foreign body feeling versus 1 of 5 standard patients (P = 0.06). Altered skin sensations were not related to a neurectomy. Hernia recurrence rate was 11.5% in the Progrip and 5% in the standard group (P = 0.05). Three years after insertion of a self-gripping Progrip mesh or a sutured polypropylene mesh for an open primary inguinal hernia repair, groin pain is minimal, although altered groin skin sensations and foreign body feeling are quite common. A Progrip hernia repair is associated with a high recurrence rate.

Sentinel Lymph Node Biopsy in the Management of Vulvar Carcinoma: An Evidence-Based Insight.

Lymph node metastasis has been shown to represent the most significant prognostic factor in vulvar carcinoma. Because only 25% to 35% of patients with early stage disease have lymph node metastases, a significant 65% to 75% possibly do not benefit from elective inguinofemoral lymphadenectomy considering the related morbidities of wound infection, breakdown, and lower limb lymphedema. This review article aims to present and summarize the evidence available with regard to sentinel lymph node (SLN)-guided management of vulvar carcinoma. A literature search was performed in MEDLINE resources using the subject headings "vulvar neoplasms," "sentinel lymph node," "sentinel lymph node biopsy," and "lymphatic metastasis." This search returned 886 articles that were published through January 2017. Prospective studies investigating sentinel node identification techniques and their impact on vulvar cancer management and prognosis were considered. Case reports were excluded from the review. Technetium-99-m-labeled nanocolloid with or without blue dye and more recently indocyanine green fluorescence have been the main techniques used for SLN identification in vulvar carcinoma. Radioisotope and near-infrared techniques have been shown to be superior to blue dye particularly with midline lesions that drain bilaterally or that drain directly to a deep pelvic node. Patients with a small unifocal primary tumor (<4 cm) and no obvious preoperative metastasis have been shown to have low groin recurrence rates and excellent disease-specific survival rates with minimal treatment-related morbidity when undergoing SLN biopsy-guided management. Sentinel lymph node biopsy-guided management seems to be safe when restricted to International Federation of Gynecology and Obstetrics IB to II cases where tumors are unifocal, less than 4 cm in size, and when there is no evidence of lymph node metastasis on clinical/radiological assessment. This reduces operative morbidity in this cohort of patients.

Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study.

Analyzing the large patient cohort of the multicenter AGO-CaRE-1 study, we compared isolated sentinel lymph node dissection (SLND) with radical lymph node dissection (LND) of the groin in relation to recurrence rates and survival. The AGO-CaRE-1 study retrospectively collected data on treatment patterns and follow-up of vulvar cancer patients [International Federation of Gynecology and Obstetrics (FIGO) stage ≥1B] treated at 29 gynecologic cancer centers between 1998 and 2008. This subgroup analysis evaluated the influence of SLND alone on progression-free survival (PFS) and overall survival (OS). In 487 (63.1%) of 772 included patients with tumors smaller than 4cm, an LND was performed and no metastatic lymph nodes were detected (LN0). Another 69/772 (8.9%) women underwent SLND alone, showing a negative SLN (SLN0). Tumors in the LN0 group were larger and showed a deeper invasion (LN0 vs. SLN0 tumor diameter: 20.0 vs. 13.0mm, p<0.001; depth of invasion: 4.0 vs. 3.0mm, p=0.002). After a median follow-up of 33months (0-156), no significant differences in relation to isolated groin recurrence rates (SLN0 3.0% vs. LN0 3.4%, p=0.845) were detected. Similarly, univariate 3-year PFS analysis showed no significant differences between both groups (SLN0 82.7% vs. LN0 77.6%, p=0.230). A multivariate Cox regression analysis, including tumor diameter, depth of invasion, age, grading, and lymphovascular space invasion was performed: PFS [hazard ratio (HR) 0.970, 95% confidence interval (CI) 0.517-1.821] and OS (HR 0.695, 95% CI 0.261-1.849) did not differ significantly between both cohorts. This subgroup analysis of the large AGO-CaRE-1 study showed similar results for groin LND and SLND alone with regard to recurrence rates and survival in node-negative patients with tumors <4cm.

Groin recurrence rate in vulvar cancer patients treated with inguinal sentinel node biopsy

Objective: Sentinel lymphnode biopsy (SNB) is an option for patients with early stage vulvar cancer, groin recurrence rates are low and therapy related morbidity is minimal compared to complete inguinofemoral lymphadenectomy. The aim of this retrospective observational study was to evaluate the safety of SNB in women with vulvar cancer by assessing the groin recurrence rate in our center.

Achievements, Investigations in Gynecologic Oncology Explored

Achievements, Investigations in Gynecologic Oncology Explored

A prospective randomised controlled trial comparing chronic groin pain and quality of life in lightweight versus heavyweight polypropylene mesh in laparoscopic inguinal hernia repair.

BACKGROUND:The aim of our study was to compare chronic groin pain and quality of life (QOL) after laparoscopic lightweight (LW) and heavyweight (HW) mesh repair for groin hernia.MATERIALS AND METHODS:One hundred and forty adult patients with uncomplicated inguinal hernia were randomised into HW mesh group or LW mesh group. Return to activity, chronic groin pain and recurrence rates were assessed. Short form-36 v2 health survey was used for QOL analysis.RESULTS:One hundred and thirty-one completed follow-up of 3 months, 66 in HW mesh group and 65 in LW mesh group. Early post-operative convalescence was better in LW mesh group in terms of early return to walking (P = 0.01) and driving (P = 0.05). The incidence of early post-operative pain, chronic groin pain and QOL and recurrences were comparable.CONCLUSION:Outcomes following laparoscopic inguinal hernia repair using HW and LW mesh are comparable in the short-term as well as long-term.