title: Repeat sentinel lymph node procedure in patients with recurrent vulvar squamous cell carcinoma is feasible.
abstract: OBJECTIVE
  Standard treatment of primary T1 squamous cell carcinoma (SCC) of the vulva <4cm consists of wide local excision (WLE) and sentinel lymph node (SLN) procedure of the groin(s). In case of a local recurrence WLE and inguino femoral lymphadenectomy (IFL) is generally recommended. In this study we assessed the feasibility of repeat SLN procedure in patients with recurrent vulvar SCC who were not able or willing to undergo IFL.
  
  
  METHODS
  A retrospective study was performed in consecutive patients with recurrent vulvar SCC who underwent a repeat SLN procedure between 2006 and 2014. We present the clinical and pathological outcomes. The study conforms to the STROBE guidelines.
  
  
  RESULTS
  A total number of 27 patients aged 35-87years at first diagnosis of SCC of the vulva were identified. Median follow-up after 2nd surgery was 27.4 (range 2-96) months. In 78% of patients and in 84% of the groins the repeat SLN procedure was successful. No structured questionnaires were used to describe details on the repeat SLN procedures but in general the gynecologic oncologists experienced repeat SLN procedures more challenging compared to primary procedures. There were no groin recurrences documented.
  
  
  CONCLUSIONS
  Our findings suggest that it is feasible to perform a repeat SLN procedure in recurrent vulvar SCC, but the procedure appears technically more challenging compared to primary setting, resulting in a lower SLN identification rate.
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus MC Cancer Institute, PO Box 2040, 3000CA Rotterdam, The Netherlands. Electronic address: h.vandoorn@erasmusmc.nl.
authors.forename: Helena C
authors.initials: HC
authors.lastname: van Doorn
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus MC Cancer Institute, PO Box 2040, 3000CA Rotterdam, The Netherlands. Electronic address: h.vanbeekhuizen@erasmusmc.nl.
authors.forename: Heleen J
authors.initials: HJ
authors.lastname: van Beekhuizen
authors.affiliation: Department of Gynecology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands. Electronic address: k.n.gaarenstroom@lumc.nl.
authors.forename: Katja N
authors.initials: KN
authors.lastname: Gaarenstroom
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. Electronic address: j.vandervelden@amc.nl.
authors.forename: Jacobus
authors.initials: J
authors.lastname: van der Velden
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands. Electronic address: a.g.j.van.der.zee@umcg.nl.
authors.forename: Ate G J
authors.initials: AG
authors.lastname: van der Zee
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands. Electronic address: m.h.m.oonk@umcg.nl.
authors.forename: Maaike H M
authors.initials: MH
authors.lastname: Oonk
authors.affiliation: Department of Obstetrics & Gynecology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500HB Nijmegen, The Netherlands. Electronic address: joanne.dehullu@radboudumc.nl.
authors.forename: Johanna A
authors.initials: JA
authors.lastname: de Hullu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006119:Groin; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012086:Reoperation; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Patients' preference; Recurrence; Sentinel node procedure; Vulvar cancer