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Release: Sept. 29, 2000

UI study: Vein-preserving surgery advantageous for women with vulvar cancer

IOWA CITY, Iowa -- Before the mid-1990s, women with vulvar cancer often developed leg problems that made walking difficult after a surgical treatment that included removal of part of the saphaneous vein, which normally drains blood from the leg. By the late 1990s, gynecologic oncologists increasingly used a new technique that does not require removing the vein.

For many women with vulvar cancer who require surgery, saphaneous vein preservation lowers the risk of subsequent leg problems without increasing the risk of recurrent cancer, according to a University of Iowa Health Care study that will appear in the Oct. 1 issue of the journal Cancer.

The success of the vein preservation technique had been studied in men with penile cancer, but no one had done a large-scale study in women with vulvar cancer, said Anil K. Sood, M.D., UI assistant professor of obstetrics and gynecology and the study's co-principal investigator.

"Traditionally, the saphaneous vein was removed because it was believed the removal would help prevent the spread of cancer," Sood said. "However, our findings suggest that it is indeed better to preserve the vein. We found no differences in recurrent rates of cancer between the two groups, yet the group with the vein preservation benefited from fewer leg problems."

Sood and the study's co-principal investigator, Sunny H. Zhang, M.D., Ph.D., who completed a UI residency in obstetrics and gynecology, led the UI research team in reviewing the cases of 83 female patients with vulvar cancer who had a procedure known as inguinal lymphadenectomy in which lymph nodes are removed for evaluating the full extent of the cancer. Some of the patients additionally had one or both saphaneous veins removed as part of the surgery. All the patients were diagnosed and treated at the UI between 1990 and 1998.

The researchers found that six months after surgery, 70 percent of the patients who underwent vein ligation, or removal, in addition to lymph node removal had leg edema, or swelling, compared with 32 percent of the patients whose lymph nodes were removed but had the vein-preserving treatment. In addition, patients whose veins were preserved had shorter hospital stays.

The results were even more telling over the long term. After two years, chronic leg swelling was present in 32 percent of the women whose veins had been removed but in only three percent whose veins were preserved. Preserving the vein also reduced the incidence of cellulitus, a painful infection.

Sood said that the leg swelling and other problems that can result from vein removal can make it difficult for people to walk.

Nearly 5,000 women in the United States are diagnosed annually with vulvar cancer. It is often seen in patients who are obese, smoke or who have high blood pressure or diabetes.

The other investigators involved in the study were UI department of obstetrics and gynecology professors Joel Sorosky, M.D., Barrie Anderson, M.D., and Richard E. Buller,
M.D., Ph.D.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.