April 1, 1992
Modified radical hemivulvectomy with ipsilateral superficial ingu9inal lymphadenectomy is an alternative to radical operation for select patients with stage I carcinoma of the vulva.
Historical comparison group from GOG 36 (588 patients who underwent radical vulvectomy and bilateral inguinofemoral lymphadenectomy): 96 patients with stage I disease, 5mm or less invasion, no LVSI, and negative inguinal and femoral nodes
Modified radical hemivulvectomy + superficial inguinal lymphadenectomy
-Depth at least 1cm below the lesion
-2cm margin of normal skin around the lesion
-Superficial inguinal lymphadenectomy w/preservation of cribriform fascia
OS, Recurrence free interval, Site of Recurrence
-Primary, previously untreated, invasive carcinoma of the vulva, Stage I (FIGO 1971)
-Vulvar lesion 2cm or less in greatest dimension (T1)
-Lymph nodes if palpable had to be nonsuspicious (N0, N1)
-Patients medically unsuited for an operation
-Prior radiation therapy or chemotherapy
-Prior malignancy other than non-melanoma skin cancer
-Intraop exclusion criteria: positive frozen section of superficial inguinal nodes
-Postop exclusion criteria: + LVSI, Max thickness > 5mm, + margins
Experimental (121) vs Controls (98)
Recurrence free interval at 5 years: 15.6% experimental vs. 7.2% historical control (SS)
Recurrence locations:
--Vulva 8.2% vs 6.2% (NS)
--Groin 7.3% (6 ipsilateral, 3 contralateral) vs 0
--"Pelvic": 1 in control
OS at 5 years: 87.6% vs 82.6% (NS)
Experimental: 7 deaths (47%) due to non-disease related reasons
Modified radical hemivulvectomy and ipsilateral inguinal lymphadenectomy is an alternative to traditional radical operation for these selected patients with stage I carcinoma of the vulva. The number of patients who experienced recurrence in the operated groin is of concern and may be attributable to the decision to leave the femoral nodes intact.