INDICATIONS FOR LYMPH NODE DISSECTION IN PATIENTS WITH VULVAR CANCER. LITERATURE REVIEW AND OWN CLINICAL OBSERVATIONS

Selection of patients with minimal vulvar cancer characterized by low metastatic rate to regional lymph nodes (LN) will allow to reduce the number of extended surgical interventions, the incidence of complications and lead to prompt rehabilitation of patients.

Aim. Determine the indications to lymph node dissection in vulvar cancer patients.

Material and methods. 252 cases of vulva cancer treatment were analyzed. The distribution by stages was: I – 58, II – 103, III – 79, IV – 12. Histologically squamous cell carcinoma was predominantly 91% (N=229). In most patients (35,5%), vulva cancer was diagnosed at the age of 61–70 years with peak manifestation at 68 years old. The vast majority of patients had therapeutic pathology. Vulvectomy and vulvectomy with lymph node dissection performed in 152 and 100 cases respectively. All patients were observed for 5 years or more.

Results. In subgroup analysis of 45 patients with minimal vulvar cancer (diameter up to 2 cm, invasion up to 5 mm) secondary disease in lymph nodes was recorded only in one (1,4%) observation. In comparison for the group of patients with invasion 5–10 mm and diameter up to 2 cm the incidence of LN metastasis was 8,3% (N=6), significantly increasing with a tumor size of more than two centimeters. In tumors with invasion of more than 5 mm and a diameter of 1,0– 2,0 cm the frequency of LN affection was almost identical – 4,2%. In tumors with invasion of more than 2,0 cm secondary disease in LN was registered significantly more often: up to 5 mm in 20,8% (N=15), 5–10 mm in 23,6% (N=17) and in case of invasion more than one centimeter in 36,1% (N=26) respectively.

Conclusion. Indications for groin lymph node dissection are formulated: 1) tumor size more than 2 cm, 2) invasion more than 5 mm, 3) multifocal tumor growth, 4) low-grade cancer, 5) localization of tumor in the clitoral region.