title: Secondary sentinel node biopsy after previous excision of the primary tumor in squamous cell carcinoma of the vulva.
abstract: BACKGROUND
  To reduce morbidity of radical groin dissection, the sentinel-node (SLN) procedure was implemented for the treatment of vulvar cancer. It has been proven to be a safe alternative in early-stage disease. Feasibility and safety of the procedure after previous vulvar surgery remain unclear.
  
  
  METHODS
  A total of 106 patients with primary vulvar cancer undergoing the SLN procedure were analyzed. Seventy-four patients received the SLN procedure concomitant to vulvar surgery [primary-sentinel group (PSG)], whereas 32 patients had vulvar surgery before secondary SLN [secondary-sentinel group (SSG)].
  
  
  RESULTS
  SLN detection was possible in all patients. Three (9.4 %) patients in the SSG and 30 (40.5 %) in the PSG had metastatic spread to the SLN and underwent radical groin dissection. Median interval between vulva surgery and secondary sentinel was 34 days (range, 7-98). In the SSG tumor, stages were earlier with smaller tumor size (median 19 mm in the PSG vs. 9 mm in the SSG) and lesser invasion depth (4 vs. 2 mm; p < 0.001). There were no groin recurrences in the SSG and 5.4 % in the PSG. No significant difference regarding disease-free survival (DFS) could be detected (3-year DFS of 72.5 % in the PSG compared with 92.5 % in the SSG (median DFS not reached, p = 0.114)). Adjusting for potential confounders (tumor stage, nodal status, tumor size, invasion depth) did not alter the results with regards to DFS.
  
  
  CONCLUSIONS
  Our results suggest that a secondary SLN procedure after previous vulvar surgery is feasible and can accurately reflect the groin status of selected patients. Ideally, prospective trials should be conducted to verify accuracy and oncologic safety of the procedure.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. lwoelber@uke.de
authors.forename: Linn
authors.initials: L
authors.lastname: Woelber
authors.forename: Donata
authors.initials: D
authors.lastname: Grimm
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.forename: Christian
authors.initials: C
authors.lastname: Wisotzki
authors.forename: Fabian
authors.initials: F
authors.lastname: Trillsch
authors.forename: Fritz
authors.initials: F
authors.lastname: Jaenicke
authors.forename: Joerg
authors.initials: J
authors.lastname: Schwarz
authors.forename: Matthias
authors.initials: M
authors.lastname: Choschzick
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006119:Groin; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects; D013997:Time Factors; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult