Selective inguinofemoral node dissection for stage III vulvar squamous cancer: feasibility and safety

Selective inguinofemoral node dissection for stage III vulvar squamous cancer: feasibility and safety | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Selective inguinofemoral node dissection for stage III vulvar squamous cancer: feasibility and safety Yan Huang, Yong Wu, Wei Zhang, Xiaohua Wu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4594320/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To assess the feasibility and outcomes of selective inguinal lymph node dissection (ILND) in stage III vulvar squamous cancer. Methods This study was approved by the Committee of Fudan University Shanghai Cancer Center. Ninety-one patients with stage III vulvar squamous cancer between 3/2018 and 3/2021 were included in this study. Thirty-one patients chose radical excision with selective ILND while 60 patients received radical excision with complete ILND voluntarily. After surgery, all the patients received postoperative external beam radiotherapy (EBRT). All the patients were invited to fill out two questionnaires: the EORTC QLQ-C30 and a vulvar specific questionnaire. Results The median follow-up time was 34 (16–50) months. There was no statistical difference in recurrence ( p >0.05) or overall survival ( p >0.05) in the two groups. Moreover, no difference in overall quality of life was observed between the two groups. The major difference was the increase in complaints of edema and body image after complete ILND. Conclusions Patients who underwent selective ILND reported less treatment related morbidity without affecting survival and overall quality of life compared to those who underwent complete ILND. Selective ILND may be a reasonable alternative for stage III vulvar squamous cancer in the future. Vulvar neoplasms therapeutics prognosis lymphadenectomy Figures Figure 1 Introduction In 2023, an estimated 6470 women will be diagnosed with vulvar cancer, and 1670 are expected to die from the disease [ 1 ]. Vulvar cancer accounts for 4% of gynecologic malignancies. Ninety percent of vulvar cancers are of squamous cell carcinoma (SCC) histology [ 2 ]. The most important prognostic factor in patients with vulvar cancer is the inguinofemoral lymph node status [ 3 , 4 ]. The aim of modern vulvar cancer treatment is to minimize treatment related morbidity without compromising survival rates. Sentinel lymph node (SLN) procedure is recommended in early-stage vulvar cancer patients [ 5 – 10 ]. According to National Comprehensive Cancer Network (NCCN) guidelines, inguinal lymph node dissection (ILND) is recommended in patients with locally advanced vulvar cancer patients. Complete ILND may lead to inguinal vascular injury, nerve injury, incision infection, and lower limb lymphedema, and so on [ 11 – 13 ]. Moreover, postoperative external beam radiotherapy (EBRT) may increase the risk of lower limb lymphedema which would cause skin itch, ulcer, hypermelanosis, mobility impairment, depression, anxiety and so on. Could we minimize the morbidity without affecting survival༟ Aims of the present study were 1) to evaluate if selective ILND followed by postoperative radiotherapy would influence prognosis for stage III vulvar squamous cancer and 2) to compare quality of life in patients who were treated by selective ILND compared to complete ILND. Materials and methods All the patients with vulvar squamous carcinoma (lesions more than 2 cm) from 2018 to 2021 received pelvic computed tomography (CT) or magnetic resonance imaging (MRI) or positron emission tomography–computed tomography (PET/CT) scan and some patients were found to have enlarged lymph nodes. Preoperative lymph node fine-needle aspiration cytology or intraoperative frozen section was done to confirm the status of lymph node metastasis. Using 2021 International Federation of Gynecology and Obstetrics (FIGO) staging system [ 14 ], 91 patients with enlarged lymph nodes were diagnosed as stage III vulvar squamous cancer and enrolled in this study. We only enrolled the stage III vulvar squamous cancer patients with enlarged lymph nodes. It was a prospective study and eligible patients were free to choose whether to enroll or not. Thirty-one patients chose radical excision with selective ILND (test group) while the other patients received radical excision with complete ILND (control group) voluntarily. They all realized the risks and benefits of the treatments and signed the informed consent forms. The inguinal lymph nodes were superficial and lymph nodes with squamous cancer cells differed significantly in texture and size. Complete ILND removed all the lymph nodes along the inguinal ligament, within the proximal femoral triangle, and deep to the cribriform fascia while selective ILND only resected the lymph nodes with suspicious carcinoma cells. After surgery, all the patients received postoperative EBRT ± concurrent chemotherapy (weekly cisplatin 40 mg/m 2 ). In general, EBRT was used to treat the vulva and inguinofemoral, external, and internal iliac nodal regions. Doses ranged from 59.4–64.8 Gy in 33–36 fractions (1.8 Gy fractions). P16 immunohistochemistry was used as a marker for human papillomavirus (HPV) infection. Clinical data including patient demographics, complications, tumor characteristics, and clinical outcomes were extracted from the electronic medical record. The patients in the study did not have preoperative signs of swelling of the lower limb, preoperative radiotherapy, and inguinal skin involvement. The patients did not receive inguinal and vulvoperineal reconstruction. We found the enlarged lymph nodes by pelvic computed tomography (CT) or magnetic resonance imaging (MRI) or positron emission tomography–computed tomography (PET/CT) scan. Then we would determine their location and number with the help of the radiologists. Because they were superficial, intraoperative exploration can further identify the number and location of enlarged lymph nodes. All statistical analyses were done with Statistic Package for Social Science (SPSS) version 16.0 (Incorporated, Chicago, Illinois). For the quality of life questionnaire, including the vulva specific part, data were analyzed in accordance with the EORTC QLQ-C30 scoring manual [ 10 , 15 ]. P < 0.05 was defined as statistically significant; all tests were 2-tailed. Pearson's chi-squared or Fisher's exact test was used to compare the differences of proportions. Continuous variables were analyzed for normal distribution with the Shapiro-Wilks test and compared with non-parametric test (Mann-Whitney). The RFS (relapse-free survival) and OS (overall survival) were analyzed by the Kaplan-Meier method. The curves were compared with the log-rank test. Cox proportional hazards regression was used to estimate hazard ratios (HRs), 95% confidence intervals (CIs) and associated p -values. Results Patients’ characteristics The median follow-up time was 34 (16-50) months. In this study, 62.6% of lymph node metastases were verified through intraoperative frozen section diagnosis and 37.4% were diagnosed by fine-needle aspiration cytology. The clinicopathologic characteristics of the patients were presented in Table 1. There were no significant differences between the two groups in age, body mass index (BMI), tumor size, tumor grade, invasion depth, lymph vascular space invasion (LVSI), positive margins, number of positive nodes, nodal spread, laterality of positive nodes, intraoperative blood loss, HPV status, or FIGO stage (Table 1). The test group had less unilateral lymph nodes resected (7.3±2.6 vs. 15.5±3.0, p =0.000), operation time (89.8±14.5 vs. 122.5±22.8 (min), p =0.000) and postoperative hospitalization (5.1±3.0 vs. 11.9±3.0 (day), p =0.000) than the control group. Comparison of RFS and OS in the two groups After surgery, 55 (60.4%) patients had postoperative radiotherapy while the rest of the patients (39.6%) received chemoradiation. The ratio of postoperative radiotherapy and chemoradiation in the two groups had no significant difference ( p =0.822). There was no statistical difference in the rate of recurrence ( p =0.374) or death ( p =0.256) in the two groups (Table 2). In terms of survival, the 2-year RFS was 41.7% in the test group and 43.3% in the control group (Figure 1). The 2-year OS was 77.4% in the test group and 76.7% in the control group (Figure 1). Univariate analyses further showed that surgical type was not an important prognostic factor for RFS (HR 1.243, 95%CI 0.626-2.465, p =0.534) and OS (HR 1.191, 95%CI 0.570-2.488, p =0.642) (Table 3). EORTC QLQ-C30 Overall, there was no difference in quality of life between patients who underwent selective ILND and those who underwent complete ILND. The quality of life-scores are shown in Table 4. There were no significant differences in functional and symptom scales between the two groups. Vulvar specific questionnaire Patients who underwent complete ILND reported more discomfort in groins, vulva and legs ( p =0.034). Complaints of lymphedema ( p = 0.000) and the need to wear stockings ( p = 0.001) were more often reported by the patients treated with complete ILND (Table 5). Patients after selective ILND were more content with the treatment they had undergone ( p =0.002) and body image ( p =0.000). Other functional and symptom scales did not show statistically significant differences. Discussion Inguinofemoral lymph node metastasis is one of the most important poor prognostic factors for vulvar squamous cancer patients. However, excessive lymph node dissection may cause longer surgery time and higher morbidity which would affect subsequent treatment and prognosis. So, it is important to remove metastatic lymph nodes while retaining intact ones. Therefore, we discussed the possibility and safety of selective ILND for stage III vulvar squamous cancer. Tailored axillary surgery, a technique for selectively removing positive lymph nodes, could contribute to reduce morbidity without affecting survival followed by radiotherapy in node-positive breast cancer patients [ 16 ]. Lymph node dissection without cancer cells is considered ineffective, may prolong the duration of surgery, and increase perioperative complications [ 17 – 20 ]. However, Mao reported that extensive lymph node dissection improves survival in node-positive penile cancer patients [ 21 ]. Another paper reported that increased lymph node counts were associated with improved prognosis in invasive intraductal papillary mucinous neoplasm patients. The cut-off value of lymph node count was 16 [ 22 ]. Rosenberger expounded that the number of nodes retrieved was associated with an increased positive nodal count in node-positive breast cancer and removal of approximately 20 lymph nodes may improve survival [ 23 ]. In addition, some articles showed that incomplete axillary lymph node dissection may lead to residual disease and cause worse prognosis [ 24 ]. Would selective ILND cause poor prognosis in node-positive vulvar squamous cancer? In this study, we found that there was no statistical difference in the rate of recurrence or death in the two groups. Univariate analyses further certified that surgical type was not associated with RFS ( p >0.05) and OS ( p >0.05). One study reported that ILND for stage III melanoma is accompanied by high wound complication rates [ 25 ]. Several studies reported that lymph node dissection in gynecologic cancer affected lower limb lymphedema and quality of life. Radiotherapy, number of lymph node dissections (≥ 28), and extensive lymph node dissection were significant risk factors for lower limb lymphedema [ 26 – 30 ]. Moreover, women who had treatment for vulvar cancer with removal of lymph nodes followed by radiotherapy were at most risk of developing lower limb lymphoedema [ 31 ]. In this study, the number of nodes retrieved in the test group is less than that in the control group ( p <0.01). There was a significant correlation between surgical approach and edema. Overall there was no difference in quality of life between patients who underwent selective ILND and those who underwent complete ILND in our study. However, patients who underwent complete ILND experienced more lymphedema and discomfort of groins and legs compared to those who had selective ILND. Also, they were less content with the operative procedure and body image. An important limitation of our study is the small study population, which unfortunately is often the case in vulvar cancer studies. Due to the rareness of this disease, some doctors might be unfamiliar with groin anatomy. According to the diagnostic criteria of imaging, we discussed the location and number of suspected enlarged metastatic lymph nodes with the radiologists before the surgery. The technique that combines CT with PET-CT and ultrasound for the selective identification of specific inguinal lymph nodes may be better for future studies on the progressive preoperative selection of lymph nodes to be removed [ 32 ]. Because the enlarged lymph nodes were superficial, intraoperative exploration can easily identify and remove them. Selective lymph node resection may be performed without exposing the femoral artery, vein, and nerves. Occasionally we need to expose the great saphenous vein and branches. The incision was small, and relatively few lymph nodes were removed. This also helped to reduce operation time, postoperative hospitalisation, edema, and bring patients up to speed on postoperative radiotherapy. Conclusions In a few words, our study showed that patients who underwent selective ILND experience less complications without having their survival affected. We believe it should be appropriate to further design a randomized controlled trial to test if selective ILND is non-inferior to complete ILND for node-positive vulvar cancer patients, in terms of curing patients and preventing recurrences. If found to be non-inferior to complete ILND, selective ILND may significantly contribute to reduced morbidity by avoiding surgical overtreatment and should become the new standard treatment for stage III vulvar squamous cancer. Declarations Authors' contributions Yan Huang and Yong Wu conceived of the study, carried out the data collection, performed the statistical analysis and drafted the manuscript. Wei Zhang screened the patients and carried out the data collection. Xiaohua Wu designed the study, enrolled the patients, checked the statistical analysis, and revised the manuscript. All the authors read and approved the final manuscript. Ethics approval and consent to participate This study was conducted according to the declaration of Helsinki and was approved by the Committee of Fudan University Shanghai Cancer Center. Written informed consents were obtained from all individual participants included in the study. Acknowledgements We would like to thank all the patients, and their family members for their kindness to support our study. Funding This work was supported by Science and Technology Commission of Shanghai Municipality (grant no. 22Y31900502) of Yan Huang. Conflict of interest The authors declare that they have no competing interests. References Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer Statistics, 2023. CA Cancer J Clin. 2023;73:17-48. Koh WJ, Greer BE, Abu-Rustum NR, Campos SM, Cho KR, Chon HS, et al. Vulvar Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017;15:92–120. Burger MP, Hollema H, Emanuels AG, Krans M, Pras E, Bouma J. The importance of the groin node status for the survival of T1 and T2 carcinoma patients. Gynecol Oncol. 1995;57:327-334. Maggino T, Landoni F, Sartori E, Zola P, Gadducci A, Alessi C, et al. Patterns of recurrence in patients with squamous cell carcinoma of the vulva. A multicenter CTF Study. Cancer. 2000;89:116-122. Van der Zee AG, Oonk MH, De Hullu JA, Ansink AC, Vergote I, Verheijen RH, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008;26:884-889. Levenback CF, Ali S, Coleman RL, Gold MA, Fowler JM, Judson PL, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol. 2012;30:3786-3791. Klapdor R, Hillemanns P, Wölber L, Jückstock J, Hilpert F, de Gregorio N, et al. Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study. Ann Surg Oncol. 2017;24:1314-1321. Covens A, Vella ET, Kennedy EB, Reade CJ, Jimenez W, Le T. Sentinel lymph node biopsy in vulvar cancer: Systematic review, meta-analysis and guideline recommendations. Gynecol Oncol. 2015;137:351-361. Oonk MH, van Hemel BM, Hollema H, de Hullu JA, Ansink AC, Vergote I, et al. Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol. 2010;11:646-652. Oonk MH, van Os MA, de Bock GH, de Hullu JA, Ansink AC, van der Zee AG. A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy. Gynecol Oncol. 2009;113:301- 305. Forner DM, Lampe B. Exenteration in the treatment of Stage III/IV vulvar cancer. Gynecol Oncol. 2012;124:87-91. Miller B, Morris M, Levenback C, Burke TW, Gershenson DM. Pelvic exenteration for primary and recurrent vulvar cancer. Gynecol Oncol. 1995;58:202-205. Hoffman MS, Cavanagh D, Roberts WS, Fiorica JV, Finan MA. Ultraradical surgery for advanced carcinoma of the vulva: an update. Int J Gynecol Cancer. 1993;3:369-372. Olawaiye AB, Cotler J, Cuello MA, Bhatla N, Okamoto A, Wilailak S, Purandare CN, Lindeque G, Berek JS, Kehoe S. FIGO staging for carcinoma of the vulva: 2021 revision. Int J Gynaecol Obstet. 2021;155:43-47. Fayers PM, Aaronson NK, Bjordal K, Curran D, Groenvold M. The EORTC QLQ-C30 Scoring Manual. 3rd ed. Brussels, European Organization for Research and Treatment of Cancer, 2001. Henke G, Knauer M, Ribi K, Hayoz S, Gérard MA, Ruhstaller T, et al. Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial. Trials. 2018;19:667. Ishiguro F, Matsuo K, Fukui T, Mori S, Hatooka S, Mitsudomi T. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg. 2010;139:1001-1006. Adachi H, Sakamaki K, Nishii T, Yamamoto T, Nagashima T, Ishikawa Y, et al. Lobe-Specific Lymph Node Dissection as a Standard Procedure in Surgery for Non-Small Cell Lung Cancer: A Propensity Score Matching Study. J Thorac Oncol. 2017;12:85-93. Kuroda H, Sakao Y, Mun M, Uehara H, Nakao M, Matsuura Y, et al. Lymph Node Metastases and Prognosis in Left Upper Division Non-Small Cell Lung Cancers: The Impact of Interlobar Lymph Node Metastasis. PLoS One. 2015;10:e0134674. Lardinois D, Suter H, Hakki H, Rousson V, Betticher D, Ris HB. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg. 2005;80:268-274. Mao W, Huang X, Kong M, Fan J, Geng J. Mao W, et al. More lymph node dissection improves survival in patients with newly diagnosed lymph node-positive penile cancer. Int Urol Nephrol. 2019;51:641-654. Wu W, Hong X, Tian R, You L, Dai M, Liao Q, et al. An Increased Total Resected Lymph Node Count Benefits Survival following Pancreas Invasive Intraductal Papillary Mucinous Neoplasms Resection: An Analysis Using the Surveillance, Epidemiology, and End Result Registry Database. PLoS One. 2014;9: e107962. Rosenberger LH, Ren Y, Thomas SM, Greenup RA, Fayanju OM, Hwang ES, et al. Axillary lymph node dissection in node-positive breast cancer: are ten nodes adequate and when is enough, enough? Breast Cancer Res Treat. 2020;179:661-670. Joshi S, Noronha J, Hawaldar R, Kundgulwar G, Vanmali V, Parmar V, et al. Merits of Level III Axillary Dissection in Node-Positive Breast Cancer: A Prospective, Single-Institution Study From India. J Glob Oncol. 2019;5:1-8. Faut M, Heidema RM, Hoekstra HJ, van Ginkel RJ, Been SL, Kruijff S, et al. Morbidity After Inguinal Lymph Node Dissections: It Is Time for a Change. Ann Surg Oncol. 2017; 24: 330–339. Kunitake T, Kakuma T, Ushijima K. Risk factors for lower limb lymphedema in gynecologic cancer patients after initial treatment. Int J Clin Oncol. 2020;25:963-971. Yoshihara M, Shimono R, Tsuru S, Kitamura K, Sakuda H, Oguchi H, et al. Risk factors for late-onset lower limb lymphedema after gynecological cancer treatment: A multi-institutional retrospective study. Eur J Surg Oncol. 2020;46:1334-1338. Pigott A, Obermair A, Janda M, Vagenas D, Ward LC, Reul-Hirche H, et al. Incidence and risk factors for lower limb lymphedema associated with endometrial cancer: Results from a prospective, longitudinal cohort study. Gynecol Oncol. 2020;158:375-381. Mendivil AA, Rettenmaier MA, Abaid LN, Brown JV 3rd, Micha JP, Lopez KL, et al. Lower-extremity lymphedema following management for endometrial and cervical cancer. Surg Oncol. 2016;25:200-204. Kuroda K, Yamamoto Y, Yanagisawa M, Kawata A, Akiba N, Suzuki K, et al. Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study. BMC Womens Health. 2017;17:50. Ryan M, Stainton MC, Slaytor EK, Jaconelli C, Watts S, Mackenzie P. Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer. Aust N Z J Obstet Gynaecol. 2003;43:148-151. Gentileschi S, Albanese R, Pino V, Stefanizzi G, Fragomeni S, Zagaria L, et al. SPECT/CT and fusion ultrasound to target the efferent groin lymph node for lymphatic surgery. Microsurgery. 2019;39:605-612. Tables Table 1. Demographic and pathologic characteristics Variables Test group (n=31) Control group (n=60) p- Value Age(years) p =0.294 ≥60 11 15 25 8 12 Tumor size(cm) p =0.162 ≤4cm 16 40 > 4cm 15 20 Tumor grade p =0.318 G1 15 23 G2 11 31 G3 5 6 HPV status p =0.727 Negative 19 39 Positive 12 21 Invasion depth p =0.297 Dermis involved 14 34 All layers involved 17 26 LVSI p =0.630 No 24 49 Yes 7 11 Positive margins No 25 56 p =0.067 Yes 6 4 Number of positive nodes p =0.826 1 15 25 2 8 18 ≥ 3 8 17 Nodal spread p =0.798 Intra-nodal growth 24 45 Extra-nodal growth 7 15 Laterality of positive nodes p =0.098 Unilateral 27 43 Bilateral 4 17 FIGO stage p =0.966 IIIA 1 2 IIIB 23 43 IIIC 7 15 Operation time(min) p =0.000* 89.8±14.5 122.5±22.8 Postoperative stay (day) p =0.000* 5.1±3.0 11.9±3.0 Lymph node counts (unilateral) p =0.000* 7.3±2.6 15.5±3.0 Blood loss(ml) p =0.152 270.7±79.0 294.5±72.5 BMI=Body mass index; HPV= human papillomavirus; LVSI= lymph vascular space invasion; FIGO=International Federation of Gynecology and Obstetrics * p ＜0.05. Table 2. Oncologic outcomes Test group (n=31) Control group (n=60) p- Value Adjuvant therapy p =0.822 Radiation only 18 37 Chemoradiation 13 23 Recurrence p =0.374 Pelvis 5 14 Abdomen 3 6 Distant 2 6 Multiple 2 4 Death p =0.256 No 22 34 Yes 9 26 Table 3. Univariate analyses of survival in patients of stage III vulvar squamous cancer Characteristics Univariate analysis HR 95%CI p- Value Surgical approach(RFS) 1.243 0.626-2.465 0.534 Surgical approach(OS) 1.191 0.570-2.488 0.642 HR=hazard ratio; CI=confidence interval; RFS=relapse-free survival; OS=overall survival Table 4. Results of 91 vulvar cancer patients answering the QLQ-C30 questionnaire Test group (n=31) mean (SD) Control group (n=60) mean (SD) p- Value Global health status/ 82（12） 85（15） 0.416 QoL Functional scales a Physical functioning 88（17） 86（16） 0.514 Role functioning 85（12） 80（17） 0.138 Emotional functioning 89（13） 85（11） 0.197 Cognitive functioning 88（12） 86（14） 0.569 Concentration 91（11） 87（13） 0.160 Memory 91（12） 90（15） 0.644 Social functioning 92（9） 89（12） 0.290 Symptom scales b Fatigue 19 (7) 18 (7) 0.637 Nausea and vomiting 3 (6) 4 (7) 0.762 Nausea 6 (2) 5 (3) 0.082 Vomiting 1(2) 2(2) 0.212 Pain 11(5) 13(5) 0.225 Dyspnoea 13(8) 15(9) 0.196 Insomnia 14(5) 12(6) 0.123 Appetite loss 9(4) 10(3) 0.118 Constipation 4(1) 5(2) 0.326 Diarrhea 12(5) 10(10) 0.592 Financial difficulties 8(2) 10(4) 0.235 a A high score on a functional scale represents a high/healthy level of functioning. b A high score on a symptom scale represents a high level of symptomatology/problems. Table 5. Results of 91 vulvar cancer patients answering the Vulva Specific Questionnaire Test group (n=31) mean (SD) Control group (n=60) mean (SD) p- Value Functional scales a Physical functioning 83（9） 83（11） 0.952 Discomfort groins/vulva/legs 82（9） 77 (11) 0.034* Discomfort sitting 88（10） 88（9） 0.955 Discomfort bending 87（7） 83（10） 0.087 Sexual functioning b 83（10） 85（11） 0.415 Future perspective 72（13） 74（13） 0.404 Body image 51（7） 35（14） 0.000* Contentment 91（8） 84（11） 0.002* Sexual activeness 7（3） 9（3） 0.127 Symptom scales c Vulvar symptoms 13（8） 15（6） 0.315 Discharge/blood loss 4（7） 2（4） 0.065 Fetor 7（4） 6（6） 0.296 Itching 24（10） 25（10） 0.296 Pain/numbness 22（8） 25（9） 0.130 Edema 13（5） 34（12） 0.000* Complaints 15（7） 35（11） 0.000* Stockings 12（5） 18（9） 0.001* Urination 15（7） 17（6） 0.341 Incontinence 20（5） 21（7） 0.256 Discomfort 15（6） 14（8） 0.613 a A higher score indicates a higher/better level of functioning/contentment. b Questions on sexual functioning were only answered by women who were sexually active. c A higher score indicates a high level of symptomatology/problems. * p ＜0.05. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4594320","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":344483559,"identity":"1109ef61-f5c4-459c-bb41-740f9808e989","order_by":0,"name":"Yan Huang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Huang","suffix":""},{"id":344483560,"identity":"9d672069-66ac-4ce2-bec8-b69f7c0cd8d8","order_by":1,"name":"Yong Wu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Wu","suffix":""},{"id":344483561,"identity":"1ee62381-87ac-4fec-9441-52a5f52cbdff","order_by":2,"name":"Wei Zhang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhang","suffix":""},{"id":344483562,"identity":"2708939e-f7d4-4526-a67b-8dfd9e1aad93","order_by":3,"name":"Xiaohua Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYDCCAxBSzgBMG1gQr8XYgIEZpEWCeC2JG8BaGIjQwne8+Zk0b9ud9O3s/Uc3/CiQYOBv707Aq0XyzDEzaZ4zz3J39hxmu9kDdJjEmbMb8GoxuJHDdpun4nDuhhvJbDd4gFoMJHKJ0WJwON0AqOXmH+K1VBxOAGm5TZQtQL+Y/5xz5rDhhjOHzW7LGEjwEPQLMMQeG7xtOyxvcLzx2c03f2zk+Nt78WvBADykKR8Fo2AUjIJRgBUAAPSCS/BtkxFTAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-6889-3541","institution":"Fudan University Shanghai Cancer Center","correspondingAuthor":true,"prefix":"","firstName":"Xiaohua","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2024-06-17 13:08:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4594320/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4594320/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66764091,"identity":"e9ba2dd8-015c-4dc6-9b4b-d4704c8192a4","added_by":"auto","created_at":"2024-10-16 09:10:59","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":240819,"visible":true,"origin":"","legend":"\u003cp\u003eRelapse-free survival and overall survival in patients of stage III vulvar squamous cancer by surgical type. A. Relapse-free survival in patients of stage III vulvar squamous cancer by surgical type (\u003cem\u003ep\u003c/em\u003e＞0.05); B. Overall survival in patients of stage III vulvar squamous cancer by surgical type (\u003cem\u003ep\u003c/em\u003e＞0.05).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4594320/v1/582228b024f125fb31ec5455.jpeg"},{"id":67575226,"identity":"60fab892-4151-4d65-bb7b-bedda2e66db6","added_by":"auto","created_at":"2024-10-27 11:49:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":882477,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4594320/v1/f3df84dd-3768-4945-bf08-adf2588a84a7.pdf"}],"financialInterests":"","formattedTitle":"Selective inguinofemoral node dissection for stage III vulvar squamous cancer: feasibility and safety","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2023, an estimated 6470 women will be diagnosed with vulvar cancer, and 1670 are expected to die from the disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Vulvar cancer accounts for 4% of gynecologic malignancies. Ninety percent of vulvar cancers are of squamous cell carcinoma (SCC) histology [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The most important prognostic factor in patients with vulvar cancer is the inguinofemoral lymph node status [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The aim of modern vulvar cancer treatment is to minimize treatment related morbidity without compromising survival rates.\u003c/p\u003e \u003cp\u003eSentinel lymph node (SLN) procedure is recommended in early-stage vulvar cancer patients [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. According to National Comprehensive Cancer Network (NCCN) guidelines, inguinal lymph node dissection (ILND) is recommended in patients with locally advanced vulvar cancer patients. Complete ILND may lead to inguinal vascular injury, nerve injury, incision infection, and lower limb lymphedema, and so on [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, postoperative external beam radiotherapy (EBRT) may increase the risk of lower limb lymphedema which would cause skin itch, ulcer, hypermelanosis, mobility impairment, depression, anxiety and so on. Could we minimize the morbidity without affecting survival༟\u003c/p\u003e \u003cp\u003eAims of the present study were 1) to evaluate if selective ILND followed by postoperative radiotherapy would influence prognosis for stage III vulvar squamous cancer and 2) to compare quality of life in patients who were treated by selective ILND compared to complete ILND.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eAll the patients with vulvar squamous carcinoma (lesions more than 2 cm) from 2018 to 2021 received pelvic computed tomography (CT) or magnetic resonance imaging (MRI) or positron emission tomography\u0026ndash;computed tomography (PET/CT) scan and some patients were found to have enlarged lymph nodes. Preoperative lymph node fine-needle aspiration cytology or intraoperative frozen section was done to confirm the status of lymph node metastasis. Using 2021 International Federation of Gynecology and Obstetrics (FIGO) staging system [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], 91 patients with enlarged lymph nodes were diagnosed as stage III vulvar squamous cancer and enrolled in this study. We only enrolled the stage III vulvar squamous cancer patients with enlarged lymph nodes. It was a prospective study and eligible patients were free to choose whether to enroll or not. Thirty-one patients chose radical excision with selective ILND (test group) while the other patients received radical excision with complete ILND (control group) voluntarily. They all realized the risks and benefits of the treatments and signed the informed consent forms. The inguinal lymph nodes were superficial and lymph nodes with squamous cancer cells differed significantly in texture and size. Complete ILND removed all the lymph nodes along the inguinal ligament, within the proximal femoral triangle, and deep to the cribriform fascia while selective ILND only resected the lymph nodes with suspicious carcinoma cells. After surgery, all the patients received postoperative EBRT\u0026thinsp;\u0026plusmn;\u0026thinsp;concurrent chemotherapy (weekly cisplatin 40 mg/m\u003csup\u003e2\u003c/sup\u003e). In general, EBRT was used to treat the vulva and inguinofemoral, external, and internal iliac nodal regions. Doses ranged from 59.4\u0026ndash;64.8 Gy in 33\u0026ndash;36 fractions (1.8 Gy fractions). P16 immunohistochemistry was used as a marker for human papillomavirus (HPV) infection. Clinical data including patient demographics, complications, tumor characteristics, and clinical outcomes were extracted from the electronic medical record. The patients in the study did not have preoperative signs of swelling of the lower limb, preoperative radiotherapy, and inguinal skin involvement. The patients did not receive inguinal and vulvoperineal reconstruction. We found the enlarged lymph nodes by pelvic computed tomography (CT) or magnetic resonance imaging (MRI) or positron emission tomography\u0026ndash;computed tomography (PET/CT) scan. Then we would determine their location and number with the help of the radiologists. Because they were superficial, intraoperative exploration can further identify the number and location of enlarged lymph nodes.\u003c/p\u003e \u003cp\u003eAll statistical analyses were done with Statistic Package for Social Science (SPSS) version 16.0 (Incorporated, Chicago, Illinois). For the quality of life questionnaire, including the vulva specific part, data were analyzed in accordance with the EORTC QLQ-C30 scoring manual [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was defined as statistically significant; all tests were 2-tailed. Pearson's chi-squared or Fisher's exact test was used to compare the differences of proportions. Continuous variables were analyzed for normal distribution with the Shapiro-Wilks test and compared with non-parametric test (Mann-Whitney). The RFS (relapse-free survival) and OS (overall survival) were analyzed by the Kaplan-Meier method. The curves were compared with the log-rank test. Cox proportional hazards regression was used to estimate hazard ratios (HRs), 95% confidence intervals (CIs) and associated \u003cem\u003ep\u003c/em\u003e-values.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatients\u0026rsquo; characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median follow-up time was 34 (16-50) months. In this study, 62.6% of lymph node metastases were verified through intraoperative frozen section diagnosis and 37.4% were diagnosed by fine-needle aspiration cytology. The clinicopathologic characteristics of the patients were presented in Table 1. There were no significant differences between the two groups in age, body mass index (BMI), tumor size, tumor grade, invasion depth, lymph vascular space invasion (LVSI), positive margins, number of positive nodes, nodal spread, laterality of positive nodes, intraoperative blood loss, HPV status, or FIGO stage (Table 1). The test group had less unilateral lymph nodes resected (7.3\u0026plusmn;2.6 vs. 15.5\u0026plusmn;3.0, \u003cem\u003ep\u003c/em\u003e=0.000), operation time (89.8\u0026plusmn;14.5 vs. 122.5\u0026plusmn;22.8 (min), \u003cem\u003ep\u003c/em\u003e=0.000) and postoperative hospitalization (5.1\u0026plusmn;3.0 vs. 11.9\u0026plusmn;3.0 (day), \u003cem\u003ep\u003c/em\u003e=0.000) than the control group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of RFS and OS in the two groups\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter surgery, 55 (60.4%) patients had postoperative radiotherapy while the rest of the patients (39.6%) received chemoradiation. The ratio of postoperative radiotherapy and chemoradiation in the two groups had no significant difference (\u003cem\u003ep\u003c/em\u003e=0.822). There was no statistical difference in the rate of recurrence (\u003cem\u003ep\u003c/em\u003e=0.374) or death (\u003cem\u003ep\u003c/em\u003e=0.256) in the two groups (Table 2). In terms of survival, the 2-year RFS was 41.7% in the test group and 43.3% in the control group (Figure 1). The 2-year OS was 77.4% in the test group and 76.7% in the control group (Figure 1). Univariate analyses further showed that surgical type was not an important prognostic factor for RFS (HR 1.243, 95%CI 0.626-2.465, \u003cem\u003ep\u003c/em\u003e=0.534) and OS (HR 1.191, 95%CI 0.570-2.488, \u003cem\u003ep\u003c/em\u003e=0.642) (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEORTC QLQ-C30\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, there was no difference in quality of life between patients who underwent selective ILND and those who underwent complete ILND. The quality of life-scores are shown in Table 4. There were no significant differences in functional and symptom scales between the two groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVulvar specific questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients who underwent complete ILND reported more discomfort in groins, vulva and legs (\u003cem\u003ep\u003c/em\u003e=0.034). Complaints of lymphedema (\u003cem\u003ep\u003c/em\u003e = 0.000) and the need to wear stockings (\u003cem\u003ep\u003c/em\u003e = 0.001) were more often reported by the patients treated with complete ILND (Table 5). Patients after selective ILND were more content with the treatment they had undergone (\u003cem\u003ep\u003c/em\u003e=0.002) and body image (\u003cem\u003ep\u003c/em\u003e=0.000). Other functional and symptom scales did not show statistically significant differences.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eInguinofemoral lymph node metastasis is one of the most important poor prognostic factors for vulvar squamous cancer patients. However, excessive lymph node dissection may cause longer surgery time and higher morbidity which would affect subsequent treatment and prognosis. So, it is important to remove metastatic lymph nodes while retaining intact ones. Therefore, we discussed the possibility and safety of selective ILND for stage III vulvar squamous cancer.\u003c/p\u003e \u003cp\u003eTailored axillary surgery, a technique for selectively removing positive lymph nodes, could contribute to reduce morbidity without affecting survival followed by radiotherapy in node-positive breast cancer patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Lymph node dissection without cancer cells is considered ineffective, may prolong the duration of surgery, and increase perioperative complications [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, Mao reported that extensive lymph node dissection improves survival in node-positive penile cancer patients [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Another paper reported that increased lymph node counts were associated with improved prognosis in invasive intraductal papillary mucinous neoplasm patients. The cut-off value of lymph node count was 16 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Rosenberger expounded that the number of nodes retrieved was associated with an increased positive nodal count in node-positive breast cancer and removal of approximately 20 lymph nodes may improve survival [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In addition, some articles showed that incomplete axillary lymph node dissection may lead to residual disease and cause worse prognosis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWould selective ILND cause poor prognosis in node-positive vulvar squamous cancer? In this study, we found that there was no statistical difference in the rate of recurrence or death in the two groups. Univariate analyses further certified that surgical type was not associated with RFS (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05) and OS (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e \u003cp\u003eOne study reported that ILND for stage III melanoma is accompanied by high wound complication rates [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Several studies reported that lymph node dissection in gynecologic cancer affected lower limb lymphedema and quality of life. Radiotherapy, number of lymph node dissections (\u0026ge;\u0026thinsp;28), and extensive lymph node dissection were significant risk factors for lower limb lymphedema [\u003cspan additionalcitationids=\"CR27 CR28 CR29\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Moreover, women who had treatment for vulvar cancer with removal of lymph nodes followed by radiotherapy were at most risk of developing lower limb lymphoedema [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In this study, the number of nodes retrieved in the test group is less than that in the control group (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01). There was a significant correlation between surgical approach and edema. Overall there was no difference in quality of life between patients who underwent selective ILND and those who underwent complete ILND in our study. However, patients who underwent complete ILND experienced more lymphedema and discomfort of groins and legs compared to those who had selective ILND. Also, they were less content with the operative procedure and body image.\u003c/p\u003e \u003cp\u003eAn important limitation of our study is the small study population, which unfortunately is often the case in vulvar cancer studies. Due to the rareness of this disease, some doctors might be unfamiliar with groin anatomy. According to the diagnostic criteria of imaging, we discussed the location and number of suspected enlarged metastatic lymph nodes with the radiologists before the surgery. The technique that combines CT with PET-CT and ultrasound for the selective identification of specific inguinal lymph nodes may be better for future studies on the progressive preoperative selection of lymph nodes to be removed [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Because the enlarged lymph nodes were superficial, intraoperative exploration can easily identify and remove them. Selective lymph node resection may be performed without exposing the femoral artery, vein, and nerves. Occasionally we need to expose the great saphenous vein and branches. The incision was small, and relatively few lymph nodes were removed. This also helped to reduce operation time, postoperative hospitalisation, edema, and bring patients up to speed on postoperative radiotherapy.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn a few words, our study showed that patients who underwent selective ILND experience less complications without having their survival affected. We believe it should be appropriate to further design a randomized controlled trial to test if selective ILND is non-inferior to complete ILND for node-positive vulvar cancer patients, in terms of curing patients and preventing recurrences. If found to be non-inferior to complete ILND, selective ILND may significantly contribute to reduced morbidity by avoiding surgical overtreatment and should become the new standard treatment for stage III vulvar squamous cancer.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYan Huang and Yong Wu conceived of the study, carried out the data collection, performed the statistical analysis and drafted the manuscript. Wei Zhang screened the patients and carried out the data collection. Xiaohua Wu designed the study, enrolled the patients, checked the statistical analysis, and revised the manuscript. All the authors read and approved the final manuscript. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted according to the declaration of Helsinki and was approved by the Committee of Fudan University Shanghai Cancer Center. Written informed consents were obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the patients, and their family members for their kindness to support our study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Science and Technology Commission of Shanghai Municipality (grant no. 22Y31900502) of Yan Huang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSiegel RL, Miller KD, Wagle NS, Jemal A. Cancer Statistics, 2023. CA Cancer J Clin. 2023;73:17-48.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKoh WJ, Greer BE, Abu-Rustum NR, Campos SM, Cho KR, Chon HS, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eVulvar Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017;15:92\u0026ndash;120.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBurger MP, Hollema H, Emanuels AG, Krans M, Pras E, Bouma J. The importance of the groin node status for the survival of T1 and T2 carcinoma patients. Gynecol Oncol. 1995;57:327-334.\u003c/li\u003e\n \u003cli\u003eMaggino T, Landoni F, Sartori E, Zola P, Gadducci A, Alessi C, \u003cem\u003eet al.\u003c/em\u003e Patterns of recurrence in patients with squamous cell carcinoma of the vulva. A multicenter CTF Study. Cancer. 2000;89:116-122.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eVan der Zee AG, Oonk MH, De Hullu JA, Ansink AC, Vergote I, Verheijen RH, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eSentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008;26:884-889.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLevenback CF, Ali S, Coleman RL, Gold MA, Fowler JM, Judson PL, \u003cem\u003eet al.\u003c/em\u003e Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol. 2012;30:3786-3791.\u003c/li\u003e\n \u003cli\u003eKlapdor R, Hillemanns P, W\u0026ouml;lber L, J\u0026uuml;ckstock J, Hilpert F, de Gregorio N, \u003cem\u003eet al.\u003c/em\u003e Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study. Ann Surg Oncol. 2017;24:1314-1321.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCovens A, Vella ET, Kennedy EB, Reade CJ, Jimenez W, Le T. Sentinel lymph node biopsy in vulvar cancer: Systematic review, meta-analysis and guideline recommendations. Gynecol Oncol. 2015;137:351-361.\u003c/li\u003e\n \u003cli\u003eOonk MH, van Hemel BM, Hollema H, de Hullu JA, Ansink AC, Vergote I, \u003cem\u003eet al.\u003c/em\u003e Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol. 2010;11:646-652.\u003c/li\u003e\n \u003cli\u003eOonk MH, van Os MA, de Bock GH, de Hullu JA, Ansink AC, van der Zee AG. A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy. Gynecol Oncol. 2009;113:301- 305.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eForner DM, Lampe B. Exenteration in the treatment of Stage III/IV vulvar cancer. Gynecol Oncol. 2012;124:87-91.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMiller B, Morris M, Levenback C, Burke TW, Gershenson DM. Pelvic exenteration for primary and recurrent vulvar cancer. Gynecol Oncol. 1995;58:202-205.\u003c/li\u003e\n \u003cli\u003eHoffman MS, Cavanagh D, Roberts WS, Fiorica JV, Finan MA. Ultraradical surgery for advanced carcinoma of the vulva: an update. Int J Gynecol Cancer. 1993;3:369-372.\u003c/li\u003e\n \u003cli\u003eOlawaiye AB, Cotler J, Cuello MA, Bhatla N, Okamoto A, Wilailak S, Purandare CN, Lindeque G, Berek JS, Kehoe S. FIGO staging for carcinoma of the vulva: 2021 revision. Int J Gynaecol Obstet. 2021;155:43-47.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFayers PM, Aaronson NK, Bjordal K, Curran D, Groenvold M. The EORTC QLQ-C30 Scoring Manual. 3rd ed. Brussels, European Organization for Research and Treatment of Cancer, 2001.\u003c/li\u003e\n \u003cli\u003eHenke G, Knauer M, Ribi K, Hayoz S, G\u0026eacute;rard MA, Ruhstaller T, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eTailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial. Trials. 2018;19:667.\u003c/li\u003e\n \u003cli\u003eIshiguro F, Matsuo K, Fukui T, Mori S, Hatooka S, Mitsudomi T. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg. 2010;139:1001-1006.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAdachi H, Sakamaki K, Nishii T, Yamamoto T, Nagashima T, Ishikawa Y, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eLobe-Specific Lymph Node Dissection as a Standard Procedure in Surgery for Non-Small Cell Lung Cancer: A Propensity Score Matching Study. J Thorac Oncol. 2017;12:85-93.\u003c/li\u003e\n \u003cli\u003eKuroda H, Sakao Y, Mun M, Uehara H, Nakao M, Matsuura Y, \u003cem\u003eet al.\u003c/em\u003e Lymph Node Metastases and Prognosis in Left Upper Division Non-Small Cell Lung Cancers: The Impact of Interlobar Lymph Node Metastasis. PLoS One. 2015;10:e0134674.\u003c/li\u003e\n \u003cli\u003eLardinois D, Suter H, Hakki H, Rousson V, Betticher D, Ris HB. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg. 2005;80:268-274.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMao W, Huang X, Kong M, Fan J, Geng J. Mao W, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eMore lymph node dissection improves survival in patients with newly diagnosed lymph node-positive penile cancer. Int Urol Nephrol. 2019;51:641-654.\u003c/li\u003e\n \u003cli\u003eWu W, Hong X, Tian R, You L, Dai M, Liao Q, \u003cem\u003eet al.\u003c/em\u003e An Increased Total Resected Lymph Node Count Benefits Survival following Pancreas Invasive Intraductal Papillary Mucinous Neoplasms Resection: An Analysis Using the Surveillance, Epidemiology, and End Result Registry Database. PLoS One. 2014;9: e107962.\u003c/li\u003e\n \u003cli\u003eRosenberger LH, Ren Y, Thomas SM, Greenup RA, Fayanju OM, Hwang ES, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eAxillary lymph node dissection in node-positive breast cancer: are ten nodes adequate and when is enough, enough? Breast Cancer Res Treat. 2020;179:661-670.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJoshi S, Noronha J, Hawaldar R, Kundgulwar G, Vanmali V, Parmar V, \u003cem\u003eet al.\u003c/em\u003e Merits of Level III Axillary Dissection in Node-Positive Breast Cancer: A Prospective, Single-Institution Study From India. J Glob Oncol. 2019;5:1-8.\u003c/li\u003e\n \u003cli\u003eFaut M, Heidema RM, Hoekstra HJ, van Ginkel RJ, Been SL, Kruijff S, \u003cem\u003eet al.\u003c/em\u003e Morbidity After Inguinal Lymph Node Dissections: It Is Time for a Change. Ann Surg Oncol. 2017; 24: 330\u0026ndash;339.\u003c/li\u003e\n \u003cli\u003eKunitake T, Kakuma T, Ushijima K. Risk factors for lower limb lymphedema in gynecologic cancer patients after initial treatment. Int J Clin Oncol. 2020;25:963-971.\u003c/li\u003e\n \u003cli\u003eYoshihara M, Shimono R, Tsuru S, Kitamura K, Sakuda H, Oguchi H, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eRisk factors for late-onset lower limb lymphedema after gynecological cancer treatment: A multi-institutional retrospective study. Eur J Surg Oncol. 2020;46:1334-1338.\u003c/li\u003e\n \u003cli\u003ePigott A, Obermair A, Janda M, Vagenas D, Ward LC, Reul-Hirche H, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eIncidence and risk factors for lower limb lymphedema associated with endometrial cancer: Results from a prospective, longitudinal cohort study. Gynecol Oncol. 2020;158:375-381.\u003c/li\u003e\n \u003cli\u003eMendivil AA, Rettenmaier MA, Abaid LN, Brown JV 3rd, Micha JP, Lopez KL, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eLower-extremity lymphedema following management for endometrial and cervical cancer. Surg Oncol. 2016;25:200-204.\u003c/li\u003e\n \u003cli\u003eKuroda K, Yamamoto Y, Yanagisawa M, Kawata A, Akiba N, Suzuki K, \u003cem\u003eet al.\u003c/em\u003e Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study. BMC Womens Health. 2017;17:50.\u003c/li\u003e\n \u003cli\u003eRyan M, Stainton MC, Slaytor EK, Jaconelli C, Watts S, Mackenzie P. Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancer. Aust N Z J Obstet Gynaecol. 2003;43:148-151.\u003c/li\u003e\n \u003cli\u003eGentileschi S, Albanese R, Pino V, Stefanizzi G, Fragomeni S, Zagaria L, \u003cem\u003eet al.\u0026nbsp;\u003c/em\u003eSPECT/CT and fusion ultrasound to target the efferent groin lymph node for lymphatic surgery. Microsurgery. 2019;39:605-612.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Demographic and pathologic characteristics\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"626\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"top\"\u003e\n \u003cp\u003eTest group (n=31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003eControl group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p-\u003c/em\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026lt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"top\"\u003e\n \u003cp\u003eBMI((kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026le;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026gt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"top\"\u003e\n \u003cp\u003eTumor size(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026le;4cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026gt; 4cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e15\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eTumor grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eG2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eG3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eHPV status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eInvasion depth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Dermis involved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; All layers involved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eLVSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003ePositive margins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eNumber of positive nodes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026ge; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eNodal spread\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Intra-nodal growth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Extra-nodal growth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eLaterality of positive nodes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Unilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Bilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.578274760383387%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.7987220447284346%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eFIGO stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e=0.966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; IIIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; IIIB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; IIIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eOperation time(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e=0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e89.8\u0026plusmn;14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e122.5\u0026plusmn;22.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003ePostoperative stay (day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e=0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"top\"\u003e\n \u003cp\u003e5.1\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e11.9\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eLymph node counts (unilateral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e=0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e7.3\u0026plusmn;2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"bottom\"\u003e\n \u003cp\u003e15.5\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003eBlood loss(ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e=0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.38019169329073%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08626198083067%\" valign=\"bottom\"\u003e\n \u003cp\u003e270.7\u0026plusmn;79.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.121405750798722%\" valign=\"top\"\u003e\n \u003cp\u003e294.5\u0026plusmn;72.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.37699680511182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0351437699680512%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI=Body mass index; HPV= human papillomavirus; LVSI= lymph vascular space invasion; FIGO=International Federation of Gynecology and Obstetrics\u003c/p\u003e\n\u003cp\u003e* \u003cem\u003ep\u003c/em\u003e＜0.05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Oncologic outcomes\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"546\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"top\"\u003e\n \u003cp\u003eTest group (n=31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003eControl group (n=60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003eAdjuvant therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e=0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Radiation only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003eChemoradiation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e=0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Pelvis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Abdomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Distant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Multiple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e=0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.937728937728938%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.007326007326007%\" valign=\"bottom\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.487179487179485%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.567765567765568%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3. Univariate analyses of survival in patients of stage III vulvar squamous cancer\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.8159509202454%\" valign=\"top\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.147239263803684%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.036809815950921%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.8159509202454%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.865030674846626%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; HR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.15950920245399%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.122699386503067%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.036809815950921%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.852760736196316%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSurgical approach(RFS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.865030674846626%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.245398773006134%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.036809815950921%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.8159509202454%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.865030674846626%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.15950920245399%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.626-2.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.122699386503067%\" valign=\"top\"\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.036809815950921%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.8159509202454%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical approach(OS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.865030674846626%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.15950920245399%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.122699386503067%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.036809815950921%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.8159509202454%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.865030674846626%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.15950920245399%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.570-2.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.122699386503067%\" valign=\"top\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.036809815950921%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHR=hazard ratio; CI=confidence interval; RFS=relapse-free survival; OS=overall survival\u003c/p\u003e\n\u003cp\u003eTable 4. Results of 91 vulvar cancer patients answering the QLQ-C30 questionnaire\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003eTest group (n=31)\u003c/p\u003e\n \u003cp\u003emean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003eControl group (n=60)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003emean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eGlobal health status/\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e82（12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e85（15）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.416\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eFunctional scales\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003ePhysical functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e88（17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e86（16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eRole functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e85（12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e80（17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eEmotional functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e89（13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e85（11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eCognitive functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e88（12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e86（14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Concentration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e91（11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e87（13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Memory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e91（12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e90（15）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eSocial functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e92（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e89（12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eSymptom scales\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e19 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e18 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eNausea and vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e3 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e4 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Nausea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e6 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Vomiting\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e1(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e2(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e11(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e13(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eDyspnoea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e13(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e15(9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eInsomnia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e14(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e12(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eAppetite loss\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e9(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e10(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eConstipation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e4(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e5(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eDiarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e12(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e10(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.635499207606973%\" valign=\"top\"\u003e\n \u003cp\u003eFinancial difficulties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.503961965134707%\" valign=\"top\"\u003e\n \u003cp\u003e8(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.94136291600634%\" valign=\"top\"\u003e\n \u003cp\u003e10(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.91917591125198%\" valign=\"top\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eA high score on a functional scale represents a high/healthy level of functioning.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u0026nbsp;\u003c/sup\u003eA high score on a symptom scale represents a high level of symptomatology/problems.\u003c/p\u003e\n\u003cp\u003eTable 5. Results of 91 vulvar cancer patients answering the Vulva Specific Questionnaire\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"640\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003eTest group (n=31) mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003eControl group (n=60)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003emean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eFunctional scales\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003ePhysical functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e83（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e83（11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Discomfort groins/vulva/legs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e82（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e77 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.034*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Discomfort sitting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e88（10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e88（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.955\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Discomfort bending\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e87（7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e83（10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eSexual functioning\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e83（10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e85（11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eFuture perspective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e72（13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e74（13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eBody image\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e51（7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e35（14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eContentment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e91（8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e84（11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eSexual activeness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e7（3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e9（3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eSymptom scales\u003csup\u003ec\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eVulvar symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e13（8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e15（6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Discharge/blood loss\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e4（7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e2（4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Fetor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e7（4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e6（6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Itching\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e24（10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e25（10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Pain/numbness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e22（8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e25（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eEdema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e13（5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e34（12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Complaints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e15（7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e35（11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Stockings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e12（5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e18（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003eUrination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e15（7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e17（6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Incontinence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e20（5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e21（7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.96875%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.1875%\" valign=\"top\"\u003e\n \u003cp\u003e15（6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59375%\" valign=\"top\"\u003e\n \u003cp\u003e14（8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\" valign=\"top\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e A higher score indicates a higher/better level of functioning/contentment.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Questions on sexual functioning were only answered by women who were sexually active.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e A higher score indicates a high level of symptomatology/problems.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* \u003cem\u003ep\u003c/em\u003e＜0.05.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vulvar neoplasms, therapeutics, prognosis, lymphadenectomy","lastPublishedDoi":"10.21203/rs.3.rs-4594320/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4594320/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo assess the feasibility and outcomes of selective inguinal lymph node dissection (ILND) in stage III vulvar squamous cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e This study was approved by the Committee of Fudan University Shanghai Cancer Center. Ninety-one patients with stage III vulvar squamous cancer between 3/2018 and 3/2021 were included in this study. Thirty-one patients chose radical excision with selective ILND while 60 patients received radical excision with complete ILND voluntarily. After surgery, all the patients received postoperative external beam radiotherapy (EBRT). All the patients were invited to fill out two questionnaires: the EORTC QLQ-C30 and a vulvar specific questionnaire.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe median follow-up time was 34 (16\u0026ndash;50) months. There was no statistical difference in recurrence (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05) or overall survival (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05) in the two groups. Moreover, no difference in overall quality of life was observed between the two groups. The major difference was the increase in complaints of edema and body image after complete ILND.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePatients who underwent selective ILND reported less treatment related morbidity without affecting survival and overall quality of life compared to those who underwent complete ILND. Selective ILND may be a reasonable alternative for stage III vulvar squamous cancer in the future.\u003c/p\u003e","manuscriptTitle":"Selective inguinofemoral node dissection for stage III vulvar squamous cancer: feasibility and safety","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-16 09:10:54","doi":"10.21203/rs.3.rs-4594320/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5ad9cc99-7efd-4c97-9d91-b1b074962e44","owner":[],"postedDate":"October 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-27T11:41:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-16 09:10:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4594320","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4594320","identity":"rs-4594320","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}