GROIN DISSECTION PRACTICES AMONG GYNECOLOGIC ONCOLOGISTS TREATING EARLY VULVAR CANCER

Objective: To survey the surgical practice of gynecologic oncologists regarding the extent of groin dissection for early vulvar cancer. Meth ods: A 14-item questionnaire was developed and presented to the Annual Meeting of the Felix Rutledge Society, Gynecologic oncologists were a sked to describe in descriptive, categorical, and visual terms the gro in procedure that they perform as part of management of early vulvar c ancers, Three ink-line drawings were created by a medical illustrator for the purpose. Fifty returned surveys were evaluable, Results: The m ost commonly performed procedures were removal of the lymph nodes abov e the cribriform fascia and those medial to the femoral vein (40%), re moval of lymph nodes above the cribriform fascia (34%), and removal of all nodes above and below the cribriform fascia (22%). Respondents pe rforming the first procedure termed it ''superficial inguinal lymphade nectomy'' (40%), ''inguinal femoral lymphadenectomy'' (25%), and a var iety of other names (35%), Respondents performing the second two proce dures were much more consistent in the figure and name that they match ed with their description of the nodes removed. When respondents were asked to match the figures with categorical definitions based on their understanding of the literature, the figure depicting Scarpa's triang le following removal of the superficial inguinal and medial femoral no des was named superficial inguinal lymphadenectomy by 24% despite the fact that the femoral vein was clearly visible and labeled, Conclusion s: We conclude that (1) among this group of gynecologic oncologists su perficial inguinal and medial femoral lymphadenectomy is the most comm only performed procedure for women with early vulvar cancer and that t he procedure is frequently called superficial inguinal lymphadenectomy ; (2) publications and protocols on this topic must provide complete d escriptions of procedures performed, and investigators must assure tha t individual surgeons are performing the same procedure; and (3) treat ment results with superficial inguinal and medial femoral lymphadenect omy are poorly described and a fertile area for further study. (C) 199 6 Academic Press, Inc.