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To assess clinical outcomes of inguinal lymph node surgical resection compared to primary groin radiotherapy for locally advanced, surgically unresectable vulvar cancer. All patients treated with radiation for vulvar cancer were identified between Jan 1, 2000 - Dec 31, 2020 at 2 academic centres. Inclusion criteria were those treated with curative intent primary radiotherapy +/− chemotherapy, tumors >4 cm, and surgically unresectable squamous cell vulvar carcinoma. Groin recurrence-free survival (RFS) was compared for groin surgery and primary groin radiotherapy using the Kaplan Meier method and log rank test. Groin failures are described by treatment modality, radiation dose and lymph node size. Of 476 patients treated with radiation for vulvar cancer, 112 patients (23.5%) met inclusion and exclusion criteria. The median (95% CI) follow up was 1.9 (1.4–2.5) years. Complete clinical response was significantly higher (80.0%) in patients with surgical groin resection compared to patients treated with primary groin radiotherapy (58.2%) (p = 0.04). On multivariable analysis, after adjusting for clinical and/or radiologically abnormal lymph nodes (p = 0.67), surgical groin resection was significantly associated with lower groin recurrence (HR 0.2 (95%CI 0.05–0.92), p = 0.04). The 3-year groin recurrence-free survival (RFS) was significantly higher at 94.4% (87.1–100) in patients with surgical groin resection compared to 79.2% (69.1–90.9) in patients treated with primary radiation (p = 0.02). In locally advanced squamous cell vulvar cancer, surgical groin management improves groin RFS compared to radiotherapy alone. • 3-year groin recurrence-free survival significantly longer with surgical groin resection compared to primary radiation. • After adjusting for abnormal lymph nodes on multivariable analysis, surgical groin resection had lower groin recurrence. • Higher radiation doses to the groin are associated with a lower rate of groin treatment failure in non-surgical candidates. [ABSTRACT FROM AUTHOR]