Laparoscopic inguinal lymph node dissection in carcinoma of the vulva: experience and intermediate results at one institution

Abstract

Objective: The goal of the study was to assess the feasibility of Laparoscopic Minimally Invasive Inguinal Lymph Node Dissection (L-MILND) for carcinoma of the vulva where sentinel lymph node biopsy could not be done. Laparoscopic Minimally Invasive Inguinal Lymph Node Dissection (L-MILND) is a procedure developed to decrease morbidity associated with inguinal lymphadenectomy while maintaining acceptable oncological outcomes. Initial experience and feasibility of this technique at the authors’ institution is reported. Setting: Dr George Mukhari Academic Hospital/Sefako Makgatho Health Sciences University. Patients: Sixteen L-MILND performed in nine patients with T1b squamous cell carcinoma of the vulva from May 2016 to April 2020. This is a retrospective analysis of the preoperative, intraoperative and postoperative characteristics. Results: The median age was 40 years (37–71 years). L-MILND’s median duration and the radical wide local excision was 223 ± 40 minutes (180 to 300 minutes). There were no intraoperative complications. The mean drain output per patient of both inguinal areas was 315 ml (50–990 ml). On average, drains were removed on day 6 (range 3–10 days). The mean number of nodes harvested was 5 (range 0–32 nodes). One patient had 1 positive node out of 32 harvested. The postoperative complications included: lymphoedema (1 groin, 6.25%), seroma (6 groins, 37.5%) and lymphorrhea (4 groins, 25.0%). Overall follow-up has been 3–50 (mean 28.3 months) months, and all patients were alive with no disease. Conclusion: The significant advantage of L-MILND appears to be the low rate of inguinal wound complications that may be associated with open procedures. This nevertheless comes at the expense of long operative times and seroma formation. This procedure is feasible and safe, though there is a need for large prospective studies with extended follow-up.