Introduction/Background*Vulvar cancer (VC) is a lymphotropic disease. The preferred lymphatic pathway involves the inguinofemoral lymph nodes (IFLNs), followed by the pelvic lymph nodes (PLNs). In selected cases, surgical approach to PLNs may be the first choice when histologic confirmation is required for suspicious involvement on imaging or when radiation therapy is out of indication (e.g., in cases of previous radiation therapy or in specific histotypes).
Given the anatomic continuity between the inguinal and pelvic sites, a novel retrograde trans-inguinal pelvic access was explored to provide concomitant lymphadenectomy, with a single skin incision and no change in surgical position or instruments.
Our objective was to evaluate the feasibility and safety of the extraperitoneal trans-inguinal novel approach to pelvic lymphadenectomy (TRIPLE).
Methodology All consecutive patients referred to our Institution in the last 18 months, affected by primary/recurrent VC, candidate to concomitant groin and pelvic lymph node surgery were included. After conventional IFLN dissection, ipsilateral extraperitoneal trans-inguinal pelvic lymphadenectomy (TRIPLE) was performed. Clinical data, type of treatment, perioperative complications and follow-up have been evaluated.
Result(s)*Thirtheen patients (8 primary, 4 recurrent VC) underwent 15 TRIPLE procedures (11 monolateral, 2 bilateral). Patients’ median age was 68 (range: 58-93); Eight of them had relevant comorbidities (61.5%). Up front locoregional radiotherapy was previously performed in three cases (23.1%). Pathology report showed: metastatic lymph nodes were found in 14 (66.7%) groins and 11 (73.3%) pelvic sites; the mean number of removed and metastatic PLNs was 13.5 (range: 5-33) and 3.2 (range: 1-18), respectively. No specific intraoperative complications occurred. One (6.7%) postoperative site-specific complication was reported (pelvic abscess, grade 2), completely restored by antibiotics. One patient died due to concomitant pneumonia. No PLN recurrence occurred during follow-up (median 9 months). Three patients (23.1%) had distant site progression (median PFS 9 months).
Conclusion*TRIPLE seems to be a feasible and safe technique, providing adequate lymph node dissection. Despite high-risk and fragile population, morbidity was similar to previously data reported for conventional mini-invasive approaches. Prospective larger comparative series are necessary.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.