Surgical treatment of vulvar cancer: results of a pilot study implementing a new lymph node classification and a brief literature review

Background. Vulvar cancer is a rare oncological disease, accounting for about 4 % of all malignant neoplasms of the female reproductive system. A characteristic feature of this disease is the predominant involvement of elderly women, which complicates treatment due to the presence of concomitant pathology. Standard surgical treatment, including radical vulvectomy with inguinal-femoral lymphadenectomy (LAE), is traditionally associated with a high risk of postoperative complications. This necessitates the development and implementation of less invasive approaches that can reduce the frequency of complications while maintaining oncological radicality. Aim. To implement and evaluate the effectiveness of a new classification of LAE volumes, developed to reduce the frequency of postoperative complications in patients with vulvar cancer. Materials and methods. The study included 37 patients with a morphologically verified diagnosis of stage IB vulvar cancer. Depending on tumor characteristics and data from instrumental research methods, patients underwent various interventions on the inguinal-femoral lymph nodes: signal lymph node biopsy using technetium (n = 10), superficial (modified) inguinal-femoral LAE (n = 13), or classical inguinal-femoral LAE (n = 14). All patients underwent radical vulvectomy. Results. Analysis of the postoperative period showed that in the groups with signal node biopsy and superficial LAE, there were no postoperative complications. At the same time, in the classical inguinal-femoral LAE group, complications were recorded in 50 % of patients. Metastatic lymph node involvement was detected in 7.6 % of cases in the superficial LAE group and in 14.2 % of cases in the classical LAE group. During the follow-up period, no disease recurrences were noted in the groups with sentinel node biopsy and superficial LAE. Conclusion. А personalized approach to selecting the extent of LAE based on the proposed classification, which takes into account the size and location of the primary tumor, significantly reduces the frequency of postoperative complications while maintaining oncological radicality.