OBJECTIVE: Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN. METHODS: We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up. RESULTS: Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was diagnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence. CONCLUSION: The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases.

1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Amsterdam University Medical Center Amsterdam the Netherlands

Cambridge University Hospitals NHS Foundation Trust Cambridge United Kingdom

Catharina Ziekenhuis Eindhoven the Netherlands

Center of Gynecological Oncology Amsterdam The Netherlands Cancer Institute Amsterdam the Netherlands

CHUM Université de Montréal Montréal Quebec Canada

Department of Obstetrics and Gynaecology European Cancer Institute Milan Italy

Erasmus MC Cancer Institute University Medical Center Rotterdam Rotterdam the Netherlands

European Translational Oncology Prevention and Screening Institute University Innsbruck Austria

Jena University Hospital Friedrich Schiller University Jena Germany

Leeds Teaching Hospitals NHS Trust St James' University Hospital Leeds United Kingdom

Leiden University Medical Center Leiden the Netherlands

Leuven Cancer Institute Leuven Belgium

Linköping University Linköping Sweden

Maastricht University Medical Center Maastricht the Netherlands

Manchester University NHS Foundation Trust St Marys Hospital Manchester United Kingdom

Medical University Graz Graz Austria

Mount Sinai Medical Center Miami Beach FL United States of America

Nottingham University Hospitals NHS Trust Nottingham United Kingdom

Radboud University Medical Center Nijmegen the Netherlands

Sahlgrenska Academy University of Gothenburg Göteborg Sweden

St Josephs Hospital and Medical Center Phoenix AZ United States of America

Stephenson Cancer Center University of Oklahoma Oklahoma City OK United States of America

The University of Texas MD Anderson Cancer Center Houston TX United States of America

University Medical Center Groningen University of Groningen Groningen the Netherlands

University Medical Center Utrecht Utrecht the Netherlands

University of Toronto Toronto Ontario Canada

Women and Infants Hospital of Rhode Island Providence RI United States of America

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European Society of Gynaecological Oncology Guidelines for the Management of Patients with Vulvar Cancer - Update 2023