The number of removed lymph nodes by inguinofemoral lymphadenectomy: impact on recurrence rates in patients with vulva carcinoma.
Inguinal lymph node (LN) metastasis is a crucial prognostic factor in vulva carcinoma. The aim of this study was to determine the prognostic value of the number of resected LNs in patients with vulvar carcinoma on recurrence rates.



This retrospective study includes patients with vulvar squamous cell carcinoma who underwent inguinofemoral lymphadenectomy (IFL) between 1998 and 2011. Dissected groins were stratified by the number of removed lymph nodes (<6 LNs versus ≥6 LNs) or inguinal LN metastasis (pN- versus pN+) and analyzed according to groin, local and distance recurrence rates.



In total 45 patients were identified and 79 groins were eligible for this analysis. 11 patients underwent ipsilateral IFL and 34 bilateral IFL. The median age was 58 years (range 31-80). The median tumor size was 2 cm (range 0.1-7.9). A median of 8 (range 0-19) LNs were resected per groin. Overall in 11 groins LN metastases were found. Groin recurrences occurred in four patients, local recurrence in six patients and distant metastasis in one patient. We did not observe any significant improvement in groin recurrence rates, local recurrence rates and distant recurrence rates if more than six LNs were removed per groin. Notably, patients with LN metastasis did not show higher recurrence rates compared to unaffected LNs.



In this cohort we demonstrated that resection of more than six LNs per groin does not improve the recurrence rates in patients with carcinoma of the vulva. Further prospective studies with more individuals are needed to evaluate the role of resected LNs in vulvar carcinoma.
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
Anja
A
Diehl
Department of Pediatric Oncology and Hematology, Children's Hospital, University of Cologne, 50924, Cologne, Germany.
Ruth
R
Volland
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
Verena
V
Kirn
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
Fabinshy
F
Thangarajah
Breast Center, Holweide Hospital, 51067, Cologne, Germany.
Christian
C
Eichler
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
Thomas
T
Einzmann
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
Marina
M
Wirtz
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
Dominik
D
Ratiu
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
Bernd
B
Morgenstern
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
Claudius
C
Fridrich
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
Peter
P
Mallmann
Department of Obstetrics and Gynecology, University Hospital of Cologne, Kerpener Str. 34, 50931, Cologne, Germany. julian.puppe@uk-koeln.de.
Julian
J
Puppe
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006119:Groin / Q000473:pathology*; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery
Lymph node metastasis; Lymphadenectomy; Recurrence rate; Vulvar carcinoma