| Objective:This study aims to compare the surgical completion degree,postoperative complications,recurrence,long-term survival rate and oncological outcomes of Video Endoscopic Inguinal Lymphadenectomy(VEIL)and Open Inguinal Lymphadenectomy(OPIL)in vulvar squamous cell carcinoma patients.Methods:OPIL group(Open Inguinal Lymphadenectomy group):Since January 2013 to July 2020 in Yunnan Cancer Hospital,the patients diagnosed as FIGO stage IB-IV vulvar squamous cell carcinoma,who accepted Radical Vulvectomy and unilateral or bilateral Open Inguinal Lymphadenectomy were retrospectively analyzed.VEIL group(Video Endoscopic Inguinal Lymphadenectomy group):From May 2018 to July 2020,patients with FIGO stage IB-IV vulvar squamous cell carcinoma,who underwent Radical Vulvectomy and unilateral or bilateral Video Endoscopic Inguinal Lymphadenectomy were prospectively enrolled in VEIL group.The basic information,the clinical information and the follow-up information were collected.We aim to analysis the degree of surgical completion,postoperative complications and survival rate.Chi square test or Fisher exact test,two independent samples t test or Mann Whitney U test and Kaplan Meier method were used to analyze the two groups of data through IBM SPSS 26.0 software(SPSS,Inc.Chicago,Ⅲ).Results:A total of 75 patients were enrolled in this study,including 44 in the OPIL group VS 31 in the VEIL group.1.Basic InformationThe age of the patients was 56(23,77)years in the VEIL group and 55(28,79)years in the OPIL group(z=-0.490,p=0.624).There were no significant differences in body mass index(BMI)(p=0.229),education level(p=0.630),diabetes mellitus(p=0.397),FIGO stage(p=0.992),distribution of lesions(p=0.475)and number of lesions(p=1.000)between the two groups.2.Clinical InformationThe operation time of unilateral Inguinofemoral Lymphadenectomy between VEIL group and OPIL group was 63.87±674 minutes VS 52.17 2±781 minutes,(t=6.155,p<0.001).The intraoperative blood loss was 10(5,15)ml in the VEIL group VS 50(20,65)ml in the OPIL group(z=-8.370,p<0.001).The number of lymph nodes was 8(6,11)in the OPIL group,10.5(8.25,12)in the OPIL group(z=-3.614,p<0.001).The length of post-operative hospital stay in the VEIL group and OPIL group was 8(8～10)days VS 11(8.25～14)days(z=-3.397,p=0.001).3.Follow UpThe median follow-up period was 29 months(range 8～96 months),21 months(range 8-33 months)in the endoscopic group and 50.5 months(range 9-96 months)in the open group.The cumulative recurrence rate of inguinal area in VEIL group and OPIL group was 10.0%VS 6.3%(p=0.667).The cumulative recurrence rate of perineum was 3.3%in VEIL group,3.1%in OPIL group(p=1.000).The cumulative recurrence rate in the distance area was 6.7%in the VEIL group,6.3%in the OPIL group(p=1.000);The cumulative recurrence rate of the two groups was 20.0%(95%confidence interval 4,8%-35.2%)in the VEIL group,and that of the OPIL group was 15.6%(95%confidence interval 2.3%～28.9%,p=0.652).A total of 11(17.7%)patients had recurrence during the follow-up period.The two-year recurrence rate was 26.3%(95%CI 46.5%-6.1%)in the VEIL group VS 12.5%(95%CI 23.9%-1.1%)in the OPIL group.During the follow-up period,the cumulative recurrence rates of the two groups were 20.0%(95%confidence interval,4.8%～35.2%)in the VEIL group VS 15.6%(95%confidence interval,2.3%～28.9%)in the OPIL group respectively,p=0.652.The recurrence rate of VEIL was slightly higher than that of OPIL,but the difference was not statistically significant.The incidence of short-term complications in the OPIL group and VEIL group were 20.0%VS 34.4%(p=0.205);The long-term complications were 3.3%VS 40.6%in the VEIL group and OPIL group(p<0.001);The incidence of complications ≥1 was 20.0%in the VEIL group,59.4%in the OPIL group(p=0.002).4.SurvivalThe 2-year disease-free survival rates of the two groups were 73.7%(95%CI 93.9%-53.5%)in the VEIL group and 87.5%(95%CI 98.9%-76.1%)in the OPIL group,p=0.603.The 2-year disease-specific survival rate was 84.3%(95%CI 100.0%-67.2%)in the VEIL group and 90.6%(95%CI 100.0%-80.4%)in the OPIL group,p=0.603.The 2-year overall survival rate was 80.3%(95%CI 98.3%-62.3%)in the VEIL group and 90.6%(95%CI 100.0%-80.4%)in the OPIL group,p=0.348.All the difference was not statistically significant.Conclusion(s):Compared with OPIL,VEIL is feasible,safe and can effectively reduce the incidence of postoperative complications.The recurrence rate of VEIL was slightly higher than that of OPIL,the 2-year DSS and OS of VEIL was slightly shorter than that of OPIL,but all the differences were not statistically significant.Longer follow-up need be continued.In the future,the comparative analysis of VEIL and OPIL should meet the prospective,multi center,completely randomized controlled factors,and achieve long-term follow-up. |
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