The Comparison Of VEIL-H With OPL In Vulvar Cancer

Objective To evaluate the feasibility and safety of the application of video endoscopic inguinal lymphadenectomy via hypogastric subcutous approach (VEIL-H) in the treatment for the vulvar carcinoma, and to compare with traditional open inguinal lymphadenectomy.Methods From August2009to December2012, all of24patients were analyzed retrospectively in seven hospitals of Zhujiang hospital, The Third Affiliated Hospital of Guangzhou Medical College, etc.15patients with vulvar cancer (8stage Ⅰ B,4Ⅱ stage,2ⅢA stage and1ⅠA stage with local recurrence after local excision in FIGO2009) who underwent VEIL-H were treated as group VEIL-H and9patients (4stage Ⅰ B,2Ⅱ stage,1ⅢA stage,1ⅢB stage and1IVA stage in FIGO2009) who underwent OPL (open inguinal lymphadenectomy, OPL) combined with radical vulvectomy were treated as group OPL. The age in group VEIL-H and OPL were (51.87±12.26years and52.44±13.33years, F=1.487, t=0.199, P=0.843). The statistics of operative time, intraoperative blood loss, intraoperative incidence, postoperative complications, postoperative average hospital stay, recurrence and follow-up time, et al were analyzed with Independent_Samples T-Test and rank-sum test in SPSS20.0for windows.Results All24patients in group VEIL-H and OPL were successfully received inguinal lymphadenectomy combined with radical vulvectomy and all of patients in two groups successfully spared saphenous vein. The comparation between group VEIL-H and OPL, there were no significant differences in time of vulvar resection(50.40±7.35min and48.11±7.24min,F=0.030, t=-1.055, P=0.298), superficial inguinal lymph node dissection(53.23±10.85min and47.39±8.30min,F=0.866, t=-1.964, P=0.056) and deep inguinal lymph node dissection(27.57±8.32min and31.11±6.48min, F=0.037, t=1.546, P=0.129), total operative time(131.20±17.43min and126.61±11.57min, F=2.821, t=-0.991, P=0.327), the number of superficial inguinal lymph node excision(5.00±1.44and4.67±1.14, F=1.487, t=0.199, P=0.843), deep inguinal lymph node excision number(3.07±0.69and2.89±0.68, F=0.001, t=-0.869, P=0.389), the blood loss in radical vulvectomy(77.0±12.58ml and80.56±11.23ml, F=0.442, t=0.986, P=0.329)(P>0.05). But the comparation between group VEIL-H and OPL, there were significant differences in superficial inguinal lymph node dissection hemorrhage(2.90±1.27ml and23.89±6.54ml, F=37.610, t=17.157, P=0.000), the amount of bleeding in deep inguinal lymph node dissection(2.70±1.32ml and3.61±1.38ml, F=0.039, t=2.281, P=0.027), postoperative hospital stay(10.80±3.47days and24.33±5.68days, F=3.223, t=0.079, P=0.000), postoperative complication rate(16.7%and77.7%, F=7.274, t=3.650, P=0.001)(P<0.05). A deep inguinal lymph node frozen results was positive in group VEIL-H, laparoscopic pelvic lymphadenectomy (LPL) was performed. In group VEIL-H,3patients with5positive inguinal lymph nodes received radiation therapy after operation; a total of6patients underwent postoperative radiotherapy or chemotherapy;2patients with more residual urine (＞150ml) recovered for two weeks’ acupuncture after the consultation of Department of traditional Chinese medicine;5of30lower limbs has postoperative complications(the rate of incidence16.7%), including2cases of unilateral inguinal lymph cyst,1case of local skin infection,1case of vulva healing,1case of lymph leakage,1case of wound dehiscence that recovered after treatment in Orthopedics;1patient suffered mild infected local wound, which improved with local treatment;2patients had left inguinal lymph cyst(4cm×4cm×3cm) on the postoperative week4,, which healed with the aspiration guided by B ultrasound and local dressing with pressure;1patient suffered lymph leakage on left groin3weeks after the surgery, which was treated by mount nitrate and recovered; no other complications occurred in the rest patients. In group OPL, there were no intraoperative frozen section results of deep inguinal lymph node positive; the total incidence rate of postoperative complications was77.7%,4patients had unilateral inguinal wound infection(the incidence rate was44.4%), which healed with secondary suture after the consultations of Department of Dermatology and plastic surgery;3cases of patients with bilateral inguinal scar contracture, the incidence rate was33.3%, resulting in lower limb dysfunction;2cases of patients resulted in lower extremity edema(the incidence rate22.2%), which was gone2months later after adopting the elastic stockings, diuretics, complementing albumin.Conclusions Compared to OPL, VEIL-H combined with RV is safe and feasible in the treatment of vulvar cancer. It has the minimally invasive advantage, avoiding the long inguinal incision of traditional open inguinal lymphadenectomy in the treatment of vulva cancer. And it can be an alternative method of inguinal lymphadenectomy in the treatment of vulvar cancer. Future studies should include the bilateral procedure, longer term follow-up and a greater number of patients.