Background: Lymph node involvement is the most important prognostic factor for recurrence and survival in vulvar cancer. Sentinel node (SN) procedure can be offered in well-selected
patients with early vulvar cancer. This study aimed to assess current management practices with
respect to the sentinel node procedure in women with early vulvar cancer in Germany. Methods: A
Web-based survey was conducted. Questionnaires were e-mailed to 612 gynecology departments.
Data were summarized as frequencies and analyzed using the chi-square test. Results: A total of
222 hospitals (36.27%) responded to the invitation to participate. Among the responders, 9.5% did
not offer the SN procedure. However, 79.5% evaluated SNs by ultrastaging. In vulvar cancer of the
midline with unilateral localized positive SN, 49.1% and 48.6% of respondents, respectively, would
perform ipsilateral or bilateral inguinal lymph node dissection. Repeat SN procedure was performed
by 16.2% of respondents. For isolated tumor cells (ITCs) or micrometastases, 28.1% and 60.5% of
respondents, respectively, would perform inguinal lymph node dissection, whereas 19.3% and 23.8%,
respectively, would opt for radiation without further surgical intervention. Notably, 50.9% of respondents would not initiate any further therapy and 15.1% would opt for expectant management.
Conclusions: The majority of German hospitals implement the SN procedure. However, only 79.5%
of respondents performed ultrastaging and only 28.1% were aware that ITC may affect survival in
vulvar cancer. There is a need to ensure that the management of vulvar cancer follows the latest
recommendations and clinical evidence. Deviations from state-of-the-art management should only
be after a detailed discussion with the concerned patient