Introduction/Background Lymph node involvement is the most important prognostic factor for recurrence and survival in cancer of the vulva. National and international guidelines differ concerning the management of pelvic lymph nodes in advanced cancer of the vulva. The German guideline recommends pelvic lymphadenectomy (PL), and radiotherapy is only performed if metastatic disease of the pelvic nodes is proven.

Methodology To assess the current management of surgical procedures concerning PL in patients with vulvar cancer, a web-based survey was e-mailed to 612 German gynecological departments. Data are presented as frequencies of selected items. Logistic regression analysis was employed to assess differences in PL procedures concerning demographic variables of the respective departments.

Results A total of 191 hospitals (31.21%) answered the questionnaire concerning the management of PL. 75.4% of participants performed a lymphadenectomy of the pelvis, even if preoperative imaging procedures showed no metastatic lymph node involvement, while 24.6% would not perform lymphadenectomy, respectively. Being a certified gyneco-oncological center significantly increased the odds of pursuing PL (OR 2.197; 95% CI 1.029–4.689; p=0.042).

74.6% of respondents performed the pelvic lymphadenectomy by laparoscopic procedure. 24.8% of respondents would remove the lymph nodes attached to the ipsilateral iliacal external vessels, 4.2% would perform this procedure bilaterally, 68.5% would perform an ipsilateral pelvic lymphadenectomy, and 12.7% would opt for a bilateral lymphadenectomy (multiple answers possible). Univariate logistic regression analyses detected no significant differences concerning the anatomical sites of the removed pelvic lymph nodes when adjusted for the demographic characteristics of the hospitals.

Conclusion Being a specialized gyneco-oncological center significantly increased the odds of adhering to German national guidelines. Nevertheless, we observed heterogeneity of surgical management concerning the potentially involved lymphatic drainage system of the pelvis. Further studies are needed to explore the optimal surgical procedure concerning pelvic lymphadenectomy in women with advanced cancer of the vulva.

Disclosures See attached files (COIs).