Researchers found that when sentinel lymph node biopsy (SLNB) results are positive despite clinically negative groin lymph nodes, there is controversy over how to treat vulvar cancer. Inguinofemoral lymphadenectomy (IFL), adjuvant chemotherapy, and radiation therapy are 2 potential treatments. Using the National Cancer Database (NCDB), researchers analyzed recent tendencies in the treatment of patients who were clinically node-negative but pathologically node-positive (cN-/pN+) (NCDB). The NCDB was consulted to track down patients with cN-/pN+ vulvar carcinoma. The demographic and clinical data were compared using the Wilcoxon rank-sum and the chi-squared tests, respectively. Analysis of the OS (overall survival) was performed using the log-rank test and Kaplan-Meier method. Cox proportional hazards regression was used to ascertain the factors related to OS. 885 cases of cN-/pN+ vulvar cancer were identified between 2012 and 2016; during this time, the rate of SLNB alone increased from 3.6% to 11.7%, while the rate of IFL +/ SLNB decreased from 89.7% to 78.1% (P<0.05). Radiation was used in 68.5% and 64.6% of cases in the SLNB-alone and IFL +/ SLNB cohorts, while chemoradiation was used in 37.1% and 33.0% of cases, respectively. Compared to patients who received IFL +/ SLNB, those who received SLNB alone did not have a longer overall survival time (P=0.644). Those who underwent chemotherapy and radiation treatment had a higher chance of survival (P<0.001). As SLNB-alone became more common and most patients received radiation +/ chemotherapy, the use of IFL decreased among NCDB patients with cN-/pN+ vulvar cancer. There was no difference in OS between SLNB alone and IFL +/ SLNB. Using chemoradiation as an adjuvant has been shown to improve patient survival. The positive results seen in the SLNB-only cohort may be attributable to the use of chemotherapy or increasing radiation doses, but this must be investigated further.