Abstract

Objective: To determine the incidence of morbidity following groin lymphadenectomy for vulvar cancer, to explore causal factors, and examine strategies to reduce morbidity.
Method: A retrospective analysis of clinical and histopathological data was conducted on patients treated for invasive cancer of the vulva at a tertiary hospital in Sydney, Australia, from 1987 to 2016.
Results: Some type of groin dissection was performed on 525 groins in 333 patients. Lymphocysts occurred in 36.6% of groins and was higher in patients having an inguino-femorallymph node dissection compared to those having groin node debulking, or a sentinel node procedure (42.5% versus 14.6% versus 0% respectively: p < 0.0001). In multivariable analysis, no significant difference in lymphocyst incidence was observed between patients with or without a groin drain. Wound breakdown occurred in 8.2% and wound infection in 10.7% of groins. Lymphedema occurred in 31.6% of lower limbs. The number of nodes resected was the only factor significantly associated with all complications, but current smoking and increasing age also increased the risk of wound breakdown.
Conclusion: A more extensive lymph node dissection is a significant risk factor for lymphocyst formation, groin wound infection, groin wound breakdown, and lower limb lymphedema. Debulking of bulky positive lymph nodes rather than complete inguino-femorallymphadenectomy reduces the risk of all post-operative complications. Our incidence of groin wound breakdown was less than 10% despite resection of the saphenous vein in all cases. Preservation of all subcutaneous fat above Camper’s fascia appears to be the most critical factor in wound healing.