Repeat sentinel lymph node procedure in patients with recurrent vulvar squamous cell carcinoma is feasible

• In recurrent vulvar cancer an inguino femoral lymphadenectomy is recommended.
• The repeat Sentinel Lymph Node (SLN) procedure is technically demanding.
• Repeat SLN procedure is feasible, but not yet a safe alternative.

ObjectiveStandard treatment of primary T1 squamous cell carcinoma (SCC) of the vulva < 4 cm consists of wide local excision (WLE) and sentinel lymph node (SLN) procedure of the groin(s). In case of a local recurrence WLE and inguino femoral lymphadenectomy (IFL) is generally recommended. In this study we assessed the feasibility of repeat SLN procedure in patients with recurrent vulvar SCC who were not able or willing to undergo IFL.MethodsA retrospective study was performed in consecutive patients with recurrent vulvar SCC who underwent a repeat SLN procedure between 2006 and 2014. We present the clinical and pathological outcomes. The study conforms to the STROBE guidelines.ResultsA total number of 27 patients aged 35–87 years at first diagnosis of SCC of the vulva were identified. Median follow-up after 2nd surgery was 27.4 (range 2–96) months. In 78% of patients and in 84% of the groins the repeat SLN procedure was successful. No structured questionnaires were used to describe details on the repeat SLN procedures but in general the gynecologic oncologists experienced repeat SLN procedures more challenging compared to primary procedures. There were no groin recurrences documented.ConclusionsOur findings suggest that it is feasible to perform a repeat SLN procedure in recurrent vulvar SCC, but the procedure appears technically more challenging compared to primary setting, resulting in a lower SLN identification rate.