High incidence of erysipelas after surgical treatment for vulvar carcinoma: An observational study

Objectives: Vulvar carcinoma is mainly treated surgically and has an overall good prognosis. Despite the development of minimally invasive surgical procedures in recent years, morbidity remains significant. The aim of the study was to determine the incidence and risk factors of erysipelas after surgical treatment for vulvar carcinoma. Methods: This retrospective observational study was performed within the Comprehensive Cancer Centre South. The study included patients (N = 116) who underwent surgery for primary vulvar carcinoma between 2005 and 2012. Patients with International Federation of Gynecology and Obstetrics stage IA and IV were excluded. Clinical and histopathological data were analyzed using logistic regression, χ2 tests, Fisher exact tests, independent t tests, and nonparametric tests. Primary outcome was the incidence of postoperative erysipelas and determination of risk factors for erysipelas. Secondary outcome included other comorbidities. Results: A total of 23 patients (20%) with vulvar carcinoma had 1 or more episodes of erysipelas. The risk of developing erysipelas was significantly higher in patients who underwent lymph node dissection than in those who underwent sentinel node biopsy (36% [n = 12] and 14% [n = 11], respectively, P = 0.008) and in patients with lymphedema than in those without (30% [n = 7] and 12% [n = 11], respectively, P = 0.048). Patients with diabetes tended to have a higher incidence of erysipelas than those without (28% vs 18%, P = 0.27). Conclusions: Erysipelas occurs frequently in patients who undergo surgical treatment for vulvar carcinoma. The risk of erysipelas is 3 times higher in patients who undergo lymph node dissection and in those with lymphedema than in those without, and it tends to be high in patients with diabetes

Incidence of inguinofemoral lymph node metastases at the first local recurrence of vulvar cancer:a Dutch nationwide study

Background: Up to 40% of vulvar cancer patients present with local recurrence within 10 years of follow-up. An inguinofemoral lymphadenectomy (IFL) is indicated if not performed at primary treatment. The incidence and risk factors for lymph node metastases (LNM) at first local recurrence, however, are unclear. Our aim was to determine the incidence of LNM at first local recurrence, in relation to previous groin treatment and clinicopathological factors. Methods: A multicenter cohort study including vulvar cancer patients with a first macroinvasive local recurrence after primary surgical treatment between 2000 and 2015 was conducted in the Netherlands. Groin status at local recurrence was defined as positive (N+), negative (N−) or unknown (N?) and based on histology, imaging and follow-up. Patient-, tumour- and treatment characteristics of primary and recurrent disease were analysed. Results: Overall, 16.3% (66/404) had a N+ groin status at first local recurrence, 66.4% (268/404) N− and 17.3% (70/404) N? groin status. The incidence of a N+ groin status was comparable after previous SLN and IFL, 11.5% and 13.8%, respectively. A N+ groin status was related to tumour size (25 vs.12 mm; P &lt; 0.001), depth of invasion (5 vs. 3 mm; P &lt; 0.001) and poorly differentiated tumours (22.9 vs. 11.9%; P = 0.050) at local recurrence. Conclusions: The incidence of LNM at first local recurrence in vulvar cancer patients was 16.3%, and independent of previous type of groin surgery. In accordance with primary diagnosis, tumour size, depth of invasion, and tumour grade were significantly associated with a positive groin status.</p