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BackgroundPerforming inguinofemoral sentinel lymph node biopsy for vulvar cancer following a previous vulvar excision, often referred to as ‘scar injection’, is debated.ObjectiveTo assess the feasibility of sentinel lymph node biopsy following scar injection and the long-term outcomes in patients undergoing this procedure.MethodsWe conducted a retrospective observational cohort study of patients with vulvar cancer. We assessed detection rates and outcomes in patients who underwent sentinel lymph node biopsy by scar injection and compared them with patients who had injection around a visible tumor and with patients who had an inguinofemoral lymphadenectomy following previous vulvar excision. Sentinel node detection rates are described per patient and per groin and are compared using Χ2analysis. Cox regression analysis was used to assess the association of recurrence and survival with surgical technique and recognized pathological variables.ResultsData were analyzed for 173 groins in 97 patients. At least one sentinel lymph node was detected in 162 (94%) groins examined, and detection rate did not differ whether the groin was assessed following tumor injection (n=122, 94%) or scar injection (n=40, 93%; p=0.85). Patients in the scar-injection group had less frequent lymph node metastases (p<0.02), smaller tumors (p<0.001), and more superficial invasion (p<0.02). Median follow-up was 34.7 months (range 0–108). Scar injection was not independently associated with recurrence or death on multivariable analysis, and depth of invasion was the only independent predictor of disease recurrence (hazards ratio (HR)=1.14, p=0.03). Recurrence and survival were also comparable for patients who had a sentinel lymph node biopsy or inguinofemoral lymphadenectomy following previous vulvar excision (log rank p=0.30; p=0.67).ConclusionsSentinel lymph node biopsy by scar injection is feasible and demonstrates similar long-term outcomes in patients having scar or tumor injections, and in patients following previous tumor excision undergoing sentinel lymph node biopsy or lymphadenectomy.

trimester. The most common presenting complaint was vaginal bleeding (37,4%) and the commonest complication was hyperthyroidism (16,6%). Twenty-six (11,2%) patients required blood transfusion. Seventeen patients (7,2%) required a second evacuation due to ongoing bleeding with 4 patients (1,7%) requiring a hysterectomy due to excessive haemorrhage. Patients with GTD normalized their HCG at a median time of 12 weeks post evacuation. There were 40 cases of persistent trophoblastic disease (PTD), all of whom had HCG levels above 6000 mIU/mL and 4000 mIU/mL at 4 weeks and 8 weeks respectively. Almost 45% of patients never completed follow-up. Conclusions The incidence of GTD within our centre is declining but remains an important cause of morbidity as it mainly affects the reproductive age. We strongly recommend a revised follow up protocol to accommodate patients with complex socio-economic backgrounds as the current protocol seems to be associated with an increase rate of loss to follow up.

group(n=115) which received(0.5% bupivacaine Hcl) as a single dose by subcutaneous infiltration at the site of incision before the skin closure, where the patients were still anaesthetized. Control group was treated with standard of care post operative systemic pain medication. The degree of pain was assessed by using visual analogue pain scores (1-10).On early postoperative day opioid consumption was also significantly reduced. Other elements of postoperative phase of ERAS program is also improved .Chi-square(x2)test, Fischer's exact test, student t test were used in data analysis. ResultsThe group treated with per operative wound infiltration with bupivacaine Hcl has lower pain score(<0.001), lower the consumption of opioid (<0.05),earlier mobilization (p <0.001),fewer consumption to bed ( p<0.001),better patient satisfaction(p<0.05) but no significant difference in complication rate. Conclusions Wound infiltration with bupivacaine Hcl into surgical site effectively reduced pain and opioid consumption and PONV .Bupivacaine Hcl is safe ,well tolerated and superior to traditional systemic pain medication in both self reported and clinical out come among the patient who underwent extensive pelvic gynae concogical surgery and enhance ERAS program EP372/#1117 TOTALLY IMPLANTABLE CENTRAL VENOUS CATHETER IN ONCOLOGIC PATIENTS: A SINGLE-CENTER EXPERIENCE