Changing trends in the surgical treatment of invasive carcinoma of the vulva

Cavabagh, D; Ws, Roberts; Bryson, S.C.Peter

doi:10.1016/0020-7292(87)90308-0

Cited by 4 publications

(9 citation statements)

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“…In Table 1, the number of unilateral lymph nodes removed from 156 women operated on is compared with the anatomic data on the number of lymph nodes in ScarpaÕ s triangle. Table 2 reports the 5-years survival rate by FIGO stages compared with the survival rate reported by those performing the classic WayÕs technique of inguinofemoral lymphadenectomy [32][33][34][35][36][37][38][39][40][41] and by the 2001 FIGO Annual Report on the results of treatment in gynecologic cancer [42].…”

Section: Resultsmentioning

confidence: 99%

Groin lymphadenectomy with Preservation of Femoral Fascia: Total Inguinofemoral Node Dissection for Treatment of Vulvar Carcinoma

2005

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This article describes a new technique for groin lymphadenectomy with preservation of the femoral fascia based on correct embryologic and anatomic knowledge of inguinofemoral lymph node disposition and their exact relation with the fascial structures of Scarpa's triangle. Scarpa's triangle dissection follows a three-step procedure: development of the side starting from the inguinal ligament; development of the angles proceeding from the apex where the saphenous vein is resected; and dissection of the fossa ovalis by grasping and elevating the entire block of adipose tissue containing the superficial inguinofemoral nodes and the stump of the great saphenous vein. This surgical step allows us to expose and remove en bloc the deep femoral nodes lying medial to the portion of the femoral vein located within the fossa ovalis. The total number of inguinofemoral nodes removed from a series of 156 patients operated on during 1981-2002 ranged from 8 to 35 (mean 20) bilaterally and from 4 to 18 (mean 10) unilaterally. The 5-year survivals by stage were, respectively, 86.2% for stage Ib, 69.2% for stage II, 49.3% for stage III, and 13.3% for stage IVa; these figures are comparable to the survival rates reported by those performing the classic groin lymphadenectomy. Groin lymphadenectomy with preservation of the femoral fascia is thus an oncologically sound conservative procedure that can replace the classic Way's technique, which involves femoral vessel skeletonization, and can be useful for treating malignant diseases requiring groin dissection.

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Section: Resultsmentioning

confidence: 99%

Groin lymphadenectomy with Preservation of Femoral Fascia: Total Inguinofemoral Node Dissection for Treatment of Vulvar Carcinoma

2005

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“…This change from clinical to surgical staging was logical. Vulvar cancer is usually treated surgically, the status of the regional lymph nodes is the single most important prognostic factor [2][3][4], and the clinical evaluation of the lymph node status is unreliable [5,6].In 1991, the Gynecologic Oncology Group (GOG) reported a survival analysis of 588 patients who were available on their database for retrospective staging according to the new system [2]. The 5-year survival was 98% for 154 patients with Stage I disease, 85% for 231 patients with Stage II disease, 74% for 141 patients with Stage III disease, and 31% for 62 patients with Stage IV disease.It became immediately apparent that the first problem with the new staging was that it did not give a good spread of prognostic groupings.…”

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confidence: 99%

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confidence: 99%

Revised FIGO staging for carcinoma of the vulva

Hacker

2009

Intl J Gynecology & Obste

113

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Staging of cancer is designed to allow valid comparison of results between centers, and to divide patients into prognostic groups. Ideally, the survival for the 4 major FIGO stages should be reasonably evenly spread between 0% and 100%.With the FIGO clinical staging system for vulvar cancer, there was a reasonable distribution of prognostic groups, 5-year survivals being 90.4%, 77.1%, 51.3% and 18.0% for Stages I, II, III, and IV, respectively [1]. This distribution reflected the fact that the incidence of lymph node metastases increased with each stage, being 10.7% for Stage I, 26.2% for Stage II, 64.2% for Stage III, and 88.9% for Stage IV [1].In 1988, the FIGO Committee on Gynecologic Oncology adopted a surgical staging system for vulvar cancer. This change from clinical to surgical staging was logical. Vulvar cancer is usually treated surgically, the status of the regional lymph nodes is the single most important prognostic factor [2][3][4], and the clinical evaluation of the lymph node status is unreliable [5,6].In 1991, the Gynecologic Oncology Group (GOG) reported a survival analysis of 588 patients who were available on their database for retrospective staging according to the new system [2]. The 5-year survival was 98% for 154 patients with Stage I disease, 85% for 231 patients with Stage II disease, 74% for 141 patients with Stage III disease, and 31% for 62 patients with Stage IV disease.It became immediately apparent that the first problem with the new staging was that it did not give a good spread of prognostic groupings. The GOG reported that when tumors had negative lymph nodes, even primary lesions up to 8 cm diameter were low risk. Some unpublished Surveillance, Epidemiology, and End Results (SEER) data have confirmed this. For 349 patients with a primary lesion greater than 8 cm diameter and negative nodes seen between 1988 and 2001, the 5-year survival was 88% [7]. We have recently reviewed our own data on 121 patients with FIGO Stages I and II vulvar cancer, and demonstrated no difference in survival between these two stages [8].A second problem with the 1988 surgical staging, identified by the GOG analysis, was that Stage III represented a heterogeneous group of patients prognostically, with survivals ranging from 100% to 34%. For example, there were 6 patients with tumors 2 cm or less involving the vagina and/or urethra, with negative nodes, and their survival was 100%. There were 47 patients who had a tumor less than 2 cm in diameter with 1 positive node, and they had a survival of 95%. On the other hand, there were 28 patients who had a tumor greater than 8 cm diameter, with 2 positive nodes, and their survival was 34%, yet all of these patients were officially classified as having Stage III disease [2].The third problem with the surgical staging system is that the number of positive nodes and the morphology of the positive nodes are not taken into account. The GOG study reported a 5-year survival of 90.9% for 385 patients with negative nodes, 75.2% for 125 patients with 1-2 positive nodes...

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“…In 1988, the International Federation of Gynecology and Obstetrics (FIGO) Committee on Gynecologic Oncology [28] adopted a surgical staging system for invasive vulval carcinoma abandoning the clinical staging after recognising that the status of the inguinofemoral lymph nodes is the single most important prognostic factor [29,30] and that the clinical evaluation of the lymph node status is unreliable [31,32].…”

Section: Management Of the Inguinofemoral Lymph Nodesmentioning

confidence: 99%