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Sentinel Node Dissection Is Safe in the Treatment of Early-Stage Vulvar Cancer

Ate G.J. Van der Zee, Maaike H. Oonk, Joanne A. De Hullu, Anca C. Ansink, Ignace Vergote, René H. Verheijen, Angelo Maggioni, Katja N. Gaarenstroom, Peter J. Baldwin, Eleonore B. Van Dorst, Jacobus Van der Velden, Ralph H. Hermans, Hans van der Putten, Pierre Drouin, Achim Schneider, Wim J. Sluiter

From the University Medical Center Groningen, University of Groningen, Groningen; Radboud University Nijmegen Medical Center, Nijmegen; Erasmus Medical Center, Rotterdam; VU University Medical Center; Academic Medical Center, Amsterdam; Leiden University Medical Center, Leiden; University Medical Center Utrecht, Utrecht; Maastricht University Medical Center, Maastricht; Catharina Hospital, Eindhoven, the Netherlands; University Hospitals Leuven, Leuven, Belgium; European Cancer Institute, Milan, Italy; Addenbrooke's Hospital, Cambridge, United Kingdom; Hôpital Notre Dame-Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada; and Charité-Universitätsmedizin Berlin, Berlin, Germany

Corresponding author: Ate G.J. Van der Zee, MD, PhD, Department of Obstetrics and Gynecology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands; e-mail: a.g.j.van.der.zee{at}og.umcg.nl

Purpose To investigate the safety and clinical utility of the sentinel node procedure in early-stage vulvar cancer patients.

Patients and Methods A multicenter observational study on sentinel node detection using radioactive tracer and blue dye was performed in patients with T1/2 (< 4 cm) squamous cell cancer of the vulva. When the sentinel node was found to be negative at pathologic ultrastaging, inguinofemoral lymphadenectomy was omitted, and the patient was observed with follow-up for 2 years at intervals of every 2 months. Stopping rules were defined for the occurrence of groin recurrences.

Results From March 2000 until June 2006, a sentinel node procedure was performed in 623 groins of 403 assessable patients. In 259 patients with unifocal vulvar disease and a negative sentinel node (median follow-up time, 35 months), six groin recurrences were diagnosed (2.3%; 95% CI, 0.6% to 5%), and 3-year survival rate was 97% (95% CI, 91% to 99%). Short-term morbidity was decreased in patients after sentinel node dissection only when compared with patients with a positive sentinel node who underwent inguinofemoral lymphadenectomy (wound breakdown in groin: 11.7% v 34.0%, respectively; P < .0001; and cellulitis: 4.5% v 21.3%, respectively; P < .0001). Long-term morbidity also was less frequently observed after removal of only the sentinel node compared with sentinel node removal and inguinofemoral lymphadenectomy (recurrent erysipelas: 0.4% v 16.2%, respectively; P < .0001; and lymphedema of the legs: 1.9% v 25.2%, respectively; P < .0001).

Conclusion 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 suggest 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.

Presented at the 11th Biennial Meeting of the International Gynecologic Cancer Society, October 14-18, 2006, Santa Monica, CA, and the Society of Gynecologic Oncologists 37th Annual Meeting on Women's Cancer, March 22-26, 2006, Palm Springs, CA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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