Patterns of care for vulval cancer treatment: the Queensland experience
To evaluate patterns of care, post-operative adverse events, and recurrence rates in patients with vulval squamous cell carcinoma, undergoing sentinel node biopsy or inguino-femoral lymph node dissection. A retrospective analysis was conducted on a cohort of 124 patients with vulval squamous cell carcinoma between 2016 and 2020 who met the study eligibility criteria. We compared the proportion of patients who underwent sentinel node biopsy versus inguino-femoral lymph node dissection, along with their rates of post-operative adverse events, recurrences, and associated socioeconomic factors. Of the 124 patients, 58 (46.8%) underwent inguino-femoral lymph node dissection, and 66 (53.2%) underwent sentinel node biopsy. The utilization of sentinel node biopsy increased over the study period from 34.5% to 57.1%. Overall, 67 of 121 patients (55.4%) experienced at least one post-operative adverse event. The incidence of adverse events was significantly higher in the inguino-femoral lymph node dissection group compared to the sentinel node biopsy group (87.9% vs 24.4%, p < .0001). Lymphoedema (n = 26, 44.8% vs n = 4, 6.4%), seroma (n = 30, 24.6% vs n = 6, 9.5%), and infections (n = 23, 19.0% vs n = 8, 12.7%) were more frequent in the inguino-femoral lymph node dissection group than in the sentinel node biopsy group. Recurrence rates and time to recurrence were comparable between groups. Socioeconomic factors had no impact on patient outcomes. Only approximately half of the patients requiring a groin lymph node assessment had a sentinel node biopsy. Morbidity associated with vulval cancer treatment remains high. Further research is warranted to reduce the treatment burden without compromising survival outcomes.