Preliminary Clinical Study Of Video Endosopic Inguinal Lymphadenectomy In Vulvar Cancer

Surgery is the cornerstone in the treatment of vulvar cancer.Inguinofemoral lymphadenectomy combined with radical vulvectomy could achieve good outcome of the treatment,but the high morbidity after radical surery has been troubled the patients for long time.The major postoperative complications were wound infection,skin necrosis,wound breakdown,lymphocyst formation,lymphorrhea,lymphedema,et al.Many modifications were adopted in order to decrease the associated high morbidity without compromised the outcome after such radical surgical procedure.And these modifications indeed decreased morbidity to some extent.However,the benefits have not been as dramatic as expected,and studies have reported relatively high rates of local complications despite these modifications.The laparoscopic method is currently routinely applied in the surgical treatment of a wide range of gynecological diseases,including malignant tumors such as cervical cancer and endometrial cancer.This method is associated with a significant reduction in intraoperative blood loss,postoperative morbidity,analgesic requirement,and the length of the hospital stay and recovery period.Gynecologic oncologists have also introduced video endoscopic inguinal lymphadenectomy(VEIL)for the management of vulvar cancer,and some preliminary studies have shown that this technique may be feasible and safe.We conduct this study to learn the feasibility and safety of VEIL for vulvar cancer.This research is divided into two parts(1).Feasibility and safety of video endoscopic inguinal lymphadenectomy in vulvar cancer:A systematic review.(2)A comparison of VEIL and OIL in the treatment of vulva cancer.Objective:To systematically review previous studies and to evaluate the feasibility and safety of video endoscopic inguinal lymphadenectomy(VEIL)in vulvar cancer.Methods:We conducted a comprehensive review of studies published through September 2014 to retrieve all relevant articles.The PubMed,EMBASE,Web of Science,Cochrane Library,Wan Fang Data and Chinese National Knowledge Infrastructure databases were systematically searched for all relevant studies published in English or Chinese through September 2014.Data were abstracted independently by two revieweres,and any differences were resolved by consensus.Results:A total of 9 studies containing 249 VEIL procedures involving 138 patients were reviewed.Of the 249 VEIL procedures,only 1(0.4%)was converted to an open procedure for suturing because of injury to the femoral vein.The range of operative time was 62 to 110 minutes,and the range of estimated blood loss was 5.5 to 22 ml.The range of the number of harvested lymph nodes was 7.3 to 16.The length of hospital stay varied from 7 to 13.6 days across reports.The incidence of lymph node metastasis was 19.7%(27/138),and the recurrence rate was 4.3%(3/70)within 3 to 41 months of follow-up.One or more short-term complications were documented in 18 of 138(13.0%)patients.Complications after VEIL were observed in 14(10.13%)patients and in 15(6.0%)of the VEIL cases,including major lymphocyst formation in 9(3.6%),lymphorrhea in 2(0.8%),inguinal wound infection without wound breakdown in 3(1.2%)and lymphedema in 1(0.4%).Conclusions:VEIL appears to be a feasible and safe procedure in the management of vulvar cancer.There may be potential benefits that result in lower morbidity compared to traditional methods,but this has yet to be objectively proven.Objective:To study the feasibility and safety of video endoscopic inguinal lymphadenectomy(VEIL)in vulvar cancer,and to learn the surgery skills about VEIL.Methods:Between January 2009 and Decemeber 2014 consecutive patients with vulvar cancer were divided into VEIL group and OIL group in Guangxi Tumor Hospital.Radical vulvectomy was conducted in both two groups.SPSS16.0 was used to analysis the data.Results:The BMI,age,pathological stage,tumor location,pathologic type in two groups were similar(P>0.05).Time for vulva dissection and reconstruction,blood loss of vulva surgery in two groups were similar(P>0.05),the total time and time for IL in VEIL group was longer than that in OIL group(P<0.05),and blood loss in VEIL was obviously less than that in OIL(P<0.05),there was no difference in harvest of lymph nodes between VEIL group and OIL group.There were significant differences in the length of hospital stay and extubation time between two groups.VEIL group has less postoperative complications like groin skin necrosis,wound breakdown,lymphorrhea,lymphedema(P<0.05).During a short term follow-up,the were no difference between two groups in the local recurrence,metastasis,and death(P>0.05).Conclusions:VEIL is a feasible and safe procedure in the treatment of vulvar cancer.VEIL can reduce the postoperative complications,shorten the length of hospital stay,while it has not increased the risk of recurrence.VEIL-H has more advantage than VEIL-L,and it seems to be more minimally invasive.