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Unilateral inguinofemoral lymphadenectomy versus bilateral inguinofemoral lymphadenectomy: the LoE 2+
risk of recurrent disease in a contralateral groin after ipsilateral groin node dissection in patients with
T1 or T2 lesions confined to the labium majus or minus is very low. Among the five identified
studies44,46,66,69,70 for a total of 295 patients, only four recurrent diseases in a contralateral groin after
ipsilateral groin node dissection have been reported (1.4%).
A case report71 of a contralateral recurrence 2.5 years after wide local excision and unilateral groin LoE 3
node dissection in a patient with a T1 lesion without clinically palpable groin nodes has been also
identified.
As part of a thesis, van der Velden72 found that 19 out of 489 patients (3.9%) with unilateral vulvar LoE 2+
tumours and negative ipsilateral lymph nodes had positive contralateral lymph nodes. In a subgroup
analysis taking into account patients with tumours < 2 cm, the incidence of contralateral lymph
nodes is only 0.9%.
Preservation of the saphenous vein: among the seven identified studies73-79, Zhang et al.73 showed LoE 2+
that preservation of the saphenous vein was associated with a statistically significant decrease in the
occurrence of cellulitis, short-term lower extremity lymphoedema, wound breakdown, and chronic
edema (18% versus 39%, p = 0.006, 32% versus 70%, p < 0.001, 13% versus 38%, p = 0.001, 32%
versus 3%, p = 0.003, respectively) compared to saphenous vein ligation without compromising the
local or distant recurrent disease rates (data not shown). Overall, the likelihood of developing no
postoperative complications was higher in the saphenous vein preservation group compared with the
saphenous vein ligation group (56% versus 23%, p < 0.001).
More recently, Zhang et al.74 reported that preservation of the saphenous vein was associated with a
statistically significant decrease by about 50% in the occurrence of chronic lower limb
lymphoedema, chronic lower extremity pain, chronic cellulitis, and sensory abnormalities (25.0%
versus 48.3%, p < 0.01, 23.2% versus 46.6%, p < 0.01, 21.4% versus 41.4%, p < 0.05, and 19.6%
versus 36.2%, p < 0.05 respectively) without compromising 5-year survival rate and groin recurrence
rate (68% versus 66.7%, p > 0.05 and 8.9% versus 12.1%, p > 0.05, respectively). Short-term lower
extremity lymphoedema and short-term lower extremity phlebitis were also less frequent in patients
treated by saphenous vein sparing surgery to those treated by lymphadenectomy with saphenous vein
ligation (43.5 versus 66.7%, p < 0.01, and 11.3% versus 25.8%, p < 0.05, respectively).
Similarly, Rouzier et al.75 reported that lymphadenectomy with saphenous vein preservation is
associated with a significant decrease in the occurrence of wound breakdown, cellulitis and
lymphoedema compared to lymphadenectomy with saphenous vein ligation (16.2% versus 36.4%, p
< 0.001, 17.7% versus 29.8%, p = 0.01, and 23.1% versus 45.3%, p < 0.001, respectively). A
significant differences in the occurrence of cellulitis and wound breakdown were also described by
Dardarian et al.76 in favour of saphenous vein sparing surgery (0% versus 45%, p < 0.001, and 0%
versus 25%, p ≤ 0.02, respectively). Subsequently, chronic lymphoedema (> 6 months) persisted in
38% of the vein-ligated group compared to 11% in the vein-spared group (p < 0.05) without
compromising the incidence of recurrent disease (19.3% versus 22.2%, p > 0.05)76.
However, preservation of the saphenous vein was not systematically associated with a statistically
significant decrease of morbidity. Zhang et al.73 observed that the difference of seroma, phlebitis,
deep vein thrombosis, and hematoma in favour of saphenous vein sparing surgery did not reach
statistical significance (3% versus 8%, p = 0.29, 0% versus 3%, p = 0.50, 2% versus 5%, p = 0.38,
0% versus 3%, p = 0.50, respectively). More recently, Zhang et al.74 observed also that the difference
of acute cellulitis, seroma, lymphocyst formation, chronic lower extremity phlebitis, and deep
venous thrombosis with saphenous vein sparing surgery did not reach statistical significance (67.7%
versus 72.7%, p > 0.05, 30.6% versus 37.9%, p > 0.05, 25.8% versus 31.8%, p > 0.05, 10.7% versus
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