Squamous cell carcinoma of the vulva with bulky positive groin nodes-nodal debulking versus full groin dissection prior to radiation therapy.

Patients with clinical palpable involved groin lymph nodes and squamous cell cancer of the vulva are frequently treated by a full inguinal-femoral lymph node dissection followed by adjuvant radiotherapy to the groins and pelvis. Theoretically, less radical surgery for the groin such as nodal debulking, where only the macroscopically involved nodes are resected, allowing radiotherapy to treat any remaining microscopic disease may potentially decrease morbidity without compromising survival The objective of this retrospective study was to compare the groin recurrence rate and survival (disease specific and overall survival) of patients with clinically involved groin nodes and squamous cell carcinoma of the vulva treated either by a full inguino-femoral lymphadenectomy or by a nodal debulking followed by radiotherapy. Forty patients from three separate databases who met these criteria were identified. Patients were treated either by a full inguino-femoral lymphadenectomy or by a debulking of the clinically involved inguinal lymph nodes. All patients received adjuvant radiotherapy to the groins. In these two groups, there was no difference in groin recurrence rate expressed as groin recurrence-free survival (P= 0.247). In a univariate analysis, both overall and disease-free survival were better in the group of patients treated by nodal debulking. However, in a multivariate analysis, other variables such as extracapsular growth were independent predictors for survival while the method of surgical dissection for the groin had no independent significant impact on survival.

Vaginal reconstruction in the fibrotic pelvis.

Vaginal reconstruction was performed in 7 patients who had developed vaginal stenosis as a result of extensive pelvic fibrosis following either pelvic irradiation (6 patients) or multiple vaginal procedures (1 patient). Six patients received split thickness skin grafts and 1 patient received an amnion graft in the creation of the neovagina. Five patients achieved a satisfactory final result. All of these patients were sexually active and described adequate sexual function. There was no serious morbidity associated with these procedures. Safe and successful vaginal reconstruction can be performed in a patient with a fibrotic pelvis.

Effects of renal failure on leukotaxis.

Effects of renal failure and experimental azotemia on in vitro leukocyte migraton were studied. Migration of normal leukocytes in sera from patients with untreated renal failure was regularly decreased, while sera from patients on chronic dialysis exerted no inhibitory effect. Serial sera obtained from two patients starting chronic dialysis exhibited a gradual decrease and ultimate disappearance of the serum inhibitory effect. Experimental azotemia serum supported increased migration of normal leukocytes. Leukocytes from renal failure patients migrated normally when incubated in autologous uremic serum or in normal homologous serum. These results provide evidence that serum from untreated renal failure patients inhibits the in vitro migration of normal leukocytes. This inhibitory capacity is apparently correctable by hemodialysis.

Squamous cell cancer of the vulva with occult lymph node metastases in the groin: the impact of surgical technique on recurrence pattern and survival.

OBJECTIVE: The triple incision technique is an established surgical method of management for early vulvar cancer. There is only limited data available on the efficacy of this form of treatment for patients with occult inguinofemoral lymph node metastases. It was the objective of this study to obtain more insight into the efficacy of this treatment compared with the en bloc resection, when utilized in surgical pathological advanced disease. METHODS: A retrospective review was performed in patients with vulvar cancer in the presence of occult inguinofemoral lymph node metastases. Tumor diameter, extracapsular nodal spread, FIGO stage, number of positive lymph nodes, and type of treatment were analyzed in relation to recurrence pattern and survival in both univariate and multivariate analyses. RESULTS: There was no significant impact of surgical technique on disease-specific and overall survival. When corrected for other prognostic variables in a multivariate analysis, the type of surgical treatment was an independent predictor for vulvar recurrence (HR 0.10, 95% CI 0.02-0.44, P = 0.002) but not for inguinal/pelvic recurrence. CONCLUSION: The type of surgical technique did not influence disease-specific and overall survival in patients with occult inguinofemoral lymph node metastases. The triple incision technique is an independent poor prognostic variable for vulvar recurrence.