Gynecologic oncology · 2026
Peripheral immune network-directed dissection of lymph node regions (iLND): Novel surgical approach for the regional assessment and therapy of vulvar carcinoma.
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Höckel Michael, Weydandt Laura, Wolf Benjamin, Keream Eman Abdel, Hüser Anika, Hinz Andreas, Thangarajah Fabinshy, Horn Lars-Christian, Kimmig Rainer, Aktas Bahriye, Dornhöfer Nadja
Аннотация
BACKGROUND: Approximately 30% of vulvar cancer patients present with node-positive disease and poor prognosis under current standards. Sentinel lymph node biopsy carries a false-negative rate exceeding 2%, often with fatal consequences, and recurrence-free survival after surgery and adjuvant radiotherapy remains below 40%. The concept of ontogenetic cancer fields links regional metastasis to pathological peripheral immune tolerance and forms the basis for immune network-directed lymph node dissection (iLND), a novel, purely surgical approach to regional disease control.
METHODS: In the prospective VFR study, node-positive patients underwent resection of inguinal and lacunar lymph node regions based on anatomic landmarks, while adjuvant radiotherapy was omitted. This enabled allocation of first-, second-, and third-line defence regions of the peripheral immune network. iLND techniques were prospectively evaluated for staging accuracy, morbidity, and oncologic outcome.
RESULTS: Fifty-five node-positive vulvar carcinomas demonstrated a hierarchical organisation of inguinal and pelvic lymph node defence lines, representing the first systematic topographical mapping of inguinal lymph node metastases. Diagnostic iLND predicted nodal status with 100% accuracy. Therapeutic iLND combined with vulvar field surgery achieved a 5-year recurrence-free survival of 64.6% (95% CI 51.6-80.8) without adjuvant radiotherapy. Lymphedema rates were 25% after diagnostic and 55% after therapeutic procedures.
CONCLUSION: iLND provides a biologically grounded and anatomically precise strategy for regional management of vulvar carcinoma. By targeting high-risk nodal regions only, it enables therapeutic de-escalation while improving survival without reliance on radiotherapy or nuclear medicine. This benefit is relevant across healthcare systems and furthermore makes iLND suitable for low-resource settings.
METHODS: In the prospective VFR study, node-positive patients underwent resection of inguinal and lacunar lymph node regions based on anatomic landmarks, while adjuvant radiotherapy was omitted. This enabled allocation of first-, second-, and third-line defence regions of the peripheral immune network. iLND techniques were prospectively evaluated for staging accuracy, morbidity, and oncologic outcome.
RESULTS: Fifty-five node-positive vulvar carcinomas demonstrated a hierarchical organisation of inguinal and pelvic lymph node defence lines, representing the first systematic topographical mapping of inguinal lymph node metastases. Diagnostic iLND predicted nodal status with 100% accuracy. Therapeutic iLND combined with vulvar field surgery achieved a 5-year recurrence-free survival of 64.6% (95% CI 51.6-80.8) without adjuvant radiotherapy. Lymphedema rates were 25% after diagnostic and 55% after therapeutic procedures.
CONCLUSION: iLND provides a biologically grounded and anatomically precise strategy for regional management of vulvar carcinoma. By targeting high-risk nodal regions only, it enables therapeutic de-escalation while improving survival without reliance on radiotherapy or nuclear medicine. This benefit is relevant across healthcare systems and furthermore makes iLND suitable for low-resource settings.