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149 Pelvic lymphadenectomy in vulvar squamous-cell cancer- a monocentric study of the relation between lymph-node involvement of groin and pelvis at the university medical center Hamburg
  1. A Jaeger1,
  2. I Fischer1,
  3. K Prieske1,
  4. S Mathey1,
  5. E Vettorazzi2,
  6. S Kuerti1,
  7. C Hillen1,
  8. J Dieckmann1,
  9. B Schmalfeldt1 and
  10. L Woelber1
  1. 1Department of Gynecology, University Medical Center Hamburg – Eppendorf, Germany
  2. 2Department of Medical Biometry and Epidemiology, University Medical Center Hamburg – Eppendorf, Germany


Background The value of pelvic lymphadenectomy (LAE) has been a subject of discussion since the early 1980s. This is mainly due to the fact that the relation between lymph-node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general.

Patients and Methods N=531 patients with primary vulvar squamous-cell cancer (VSCC) FIGO stage ≥ 1B were treated at the University Medical Center Hamburg – Eppendorf (UKE)between 1996–2018. In this analysis only patients with pelvic LAE (n=21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph-node involvement.

Results The majority had T1b/T2 tumors (n=15,71.4%) with a median diameter of 40 mm (11–110 mm). Only 17/21 patients were inguinally node-positive. Pelvic nodal involvement without groin metastases was not observed. 6/17 node-positive patients also had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5(1–8)). These 6 patients were highly node positive with median 4.5 (2–9) affected groin nodes. With regard to the metastatic spread between groins and pelvis, no contralateral spread was observed.

Four recurrences were observed after a median FU of 33.5 months. No pelvic recurrences were observed in the pelvic nodal positive group; while 33.3% experienced recurrences at distant sites (2/6). Patients with pelvic metastasis at first diagnosis had a progression-free survival of only 25.6 months.

Conclusion A relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, therefore pelvic nodal staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC.

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