Overview and Aims:

In early vulvar cancer, lymph node status is the most important prognostic factor. Sentinel lymph node biopsy (SLNB) is the minimally invasive procedure that leads to the most significant reduction in the classical high morbidity associated with the systematic inguinofemoral lymphadenectomy. Besides quality control, the aim of this study is to document and monitor the overall experience around SLNB at a referral Centre.

Study design:

Retrospective study.

Population:

All cases of vulvar carcinoma where SLNB was performed as part of the treatment for vulvar cancer at the authors’ Department, from January, 2016 to December, 2019 meeting the criteria: unifocal tumour confined to the vulva, tumour size < 4 cm, stromal invasion > 1 mm and no evidence of inguinal metastasis.

Methods:

Detailed description of the technique used in lymphoscintigraphy, SLNB, primary tumour treatment and histopathology with analysis of patient files collecting data of demographics, pathology, accuracy, surgery, perioperative results, feasibility and survival.

Results:

The average age was 68 years and Charlson score ≥ 5 was 55.6%. Primary site was labia majora in 44.4% and mid-line was affected in 27.8%. Mean tumour diameter was 20.2 mm. SLN detection rate was 100%, bilateral in 27.8%. 1 out of 38 nodes removed was positive and average number of nodes per patient was 2.1. There were no intraoperative complications. A single case of groin recurrence in 15 months mean follow-up time and 2 cases of non-related deaths occurred. 27.8% and 5.6% patients had short and long-term postoperative complications, respectively, mostly infectious. The average global survival/disease-free survival was 45.1/44.7 months.

Conclusions:

SLNB is a reliable and safe minimally invasive technique that should be performed by experienced gynaecological oncologists in well-equipped and multidisciplinary Centres. A rigorous preoperative planning combined with multidisciplinary surgical coordination are cornerstones for the success of this procedure applied to early-stage vulvar cancer.

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