Vulvar cancer

INGUINOSCOPY FOR VULVAR CANCER

• Report rights infringement
• published: 08 Apr 2015
• views: 4526

Objective: Development of a new surgical technique in order to reduce the complications of groin lymph node dissection without impairing the chances of survival. Material and Methods: The surgical technique is based on video-endoscopic subcutaneous dissection. The gasless technique with a lifting system holding the skin of the femoral triangle is used. Dissection of all superficial and deep femoral nodes is performed through two small skin incisions with endoscopic instruments under video control. The femoral vessels are cleared. The great saphenous vein, superficial pudendal and superficial epigastric vessels, and the circumflex artery are preserved. From December 1995 to May 1999, 41 endoscopic groin dissections were performed in 25 cases of vulvar cancer and in 3 cases of lower third vaginal neoplasia. Vulvar cancers were stage I in 12 cases, stage Il in 9 cases and stage III in 4 cases; the size of the lesion was between 10 to 65 mm. The vaginal cancers were stage Il in 2 cases and stage III in 1 case. The dissection was performed on the ipsilateral side of the tumor in 9 patients, on the contra lateral side in 6 cases (in case of clinically suspected inguinal nodes a traditional open dissection was performed), and on both sides in 13 patients. Results: The mean duration of the endoscopic dissection was 62 minutes (range 43 - 120). The mean number of lymph nodes removed was 7 (range 2-15). The only peri-operative complication was an injury to the femoral vein requiring the opening of the skin for suturing. The mean hospital stay was 11 days, but in case of endoscopic groin dissection performed alone, it was only 3.5 days. We had 4 cases of metastatic nodes: two were positive on frozen section leading to a classical inguinal and external iliac open dissection, and 2 were observed on the final pathology report. We had 1 recurrence. It occurred 3 months after inguinoscopy and was localized under the skin, between the vulva and the inguinal area. No wound breakdown or lymphedema were observed. Only 7 lymphocyts requiring needle aspiration occurred. Conclusion: This surgical technique decreased the risk of post-operative complications of groin dissection. Its value in oncologic field needs to be further studied in particular in association with sentinel node study.