[Minimizing operative morbidity. Sentinel-lymphonodectomy in vulvar cancer -- quo vadis?]

Complete groin dissection is established in the operative standard procedure in treatment of vulvar carcinoma. For lateral localized carcinomas without node metastases only ipsilateral dissection is necessary. But in early tumor stages most of the patients are node negative and no oncologic benefit can be postulated although operative morbidity is high. Only for carcinomas with depth of infiltration less than 1 mm it is possible to avoid groin dissection. Studies demonstrate that clinical and apparative diagnostic procedures do not predict lymph node involvement accurately. Thus the concept of sentinel-lymphonodectomy has been evaluated in the last years in vulvar carcinoma. With > 95 % detection rate was very high and false negative cases have been reported only very rarely. Because results with the first patients in Germany showed similar results the AGO developed a concept for an observational study which will avoid complete groin dissection in sentinel node negative T1-T2N0 vulvar carcinoma. Before participation is possible e learning phase has to be completed. Exact control of the patients should look for reduction of operative morbidity with equivalent oncologic effectiveness.