Characteristics of recurrence in patients who underwent lymphatic mapping for vulvar cancer

Objective: To evaluate patients with vulvar cancer who recurred after lymphatic mapping and sentinel lymph node (SLN) biopsy. Methods: We reviewed 52 cases of vulvectomy and lymphatic mapping with blue dye for treatment of vulvar cancer from 1993-1999 and identified patients with recurrence. Results: Fourteen patients (27%) were included. Median age was 60.4 years. Nine patients had squamous lesions, four had melanoma and one had Paget's. Four tumors were Tl lesions, 7 were T2 lesions and 3 were T3 lesions. Eight lesions were midline while 6 were lateral. Thirteen patients had complete lymphadenectomy while one had SLN biopsy only. Postoperatively, 7 patients received no treatment, 6 patients received radiation and 1 patient received chemotherapy. Median follow-up was 46 months. Median disease free interval was 21 months. Nine patients (64%) had local recurrences, 3 had groin recurrence (21%) and 2 had distant recurrence (14%). Body weight was a significant prognostic factor for recurrence (P = 0.008). A significant difference was also observed among histologie type: 9 of 32 squamous lesions (22%) recurred while 4 of 7 melanomas (57%) recurred (P £0.05). At least one SLN was identified in 46 of the 52 patients. One recurred when no SLN was identified (17%), while 13 (28%) recurred when a SN was identified (P = 0.5). For patients with negative SLN, the recurrence rate was 24% compared to 40% for patients with a positive SLN (P = 0.6). Three patients recurred in the groin, one had negative SLN and non-SLN, one had a positive SLN and positive non-SLN and one had no SLN identified and a negative non-SLN. Conclusions: This heterogeneous group of patients undergoing lymphatic mapping had similar patterns of recurrence as described in the literature. Groin relapse following negative SLN biopsy or negative lymphadenectomy remains a concern. More long-term follow-up data is required before lymphatic mapping and SLN biopsy alone can be considered a standard in patients with invasive vulvar cancer.