title: Quality of life after complete lymphadenectomy for vulvar cancer: do women prefer sentinel lymph node biopsy?
abstract: OBJECTIVE
  Leg lymphoedema occurs in up to 60% of women after a complete inguinal-femoral lymphadenectomy for vulvar cancer. To avoid lymphoedema, sentinel lymph node biopsy has become the preferred method of staging. However, false-negative results may influence survival, making the sentinel node procedure unacceptable to many fully informed women. The aims of this study were to measure the quality of life (QoL) in women after a complete lymphadenectomy for vulvar cancer and to quantify the risk to survival these women would be prepared to take with sentinel node biopsy.
  
  
  METHODS
  Sixty women who had a complete lymphadenectomy for early-stage vulvar cancer participated in structured interviews. The severity of lymphoedema symptoms was recorded. The QoL-adjusted survival was measured using the Utility-Based Questionnaire-Cancer, a cancer-specific validated QoL instrument. The women stated their preference for sentinel node biopsy or complete lymphadenectomy. A "standard-gamble" preference table was used to quantify the degree of risk to survival they would take to avoid lymphoedema.
  
  
  RESULTS
  Seventy-three percent of women reported lymphoedema after complete lymphadenectomy. Women with lymphoedema or leg pain had significantly worse scores for QoL in terms of social activity as well as physical and sexual function. Overall, 80% of women would choose complete lymphadenectomy rather than sentinel node biopsy if the risk of missing a positive lymph node was higher than 1 in 100, but if the risk of missing a positive lymph node was lower than 1 in 100, almost one third of the women would prefer sentinel node biopsy.
  
  
  CONCLUSIONS
  Although women treated for early-stage vulvar cancer report reduced QoL after complete lymphadenectomy, most would choose complete lymphadenectomy over sentinel node biopsy. However, there is an individual level of risk that each woman can define with regard to her preference for the sentinel node procedure. Women with early-stage vulvar cancer should be offered an informed choice between complete lymphadenectomy or sentinel node biopsy.
authors.affiliation: *Royal Hospital for Women, University of New South Wales; and †University of Sydney National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Farrell
authors.forename: Val
authors.initials: V
authors.lastname: Gebski
authors.forename: Neville F
authors.initials: NF
authors.lastname: Hacker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000523:psychology / Q000601:surgery*; D002755:Choice Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D011379:Prognosis; D011788:Quality of Life; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014846:Vulvar Neoplasms / Q000150:complications / Q000523:psychology / Q000601:surgery*