Epidermoid carcinoma of the anal region: Inguinal metastases

Abstract

1. 1. Sixty-nine cases of epidermoid carcinoma of the anal region seen at Memorial Center between January, 1942, and December, 1952, have been reviewed. 2. 2. Forty of the sixty-nine patients did not present clinically recognizable groin metastases. Twenty-nine or 42 per cent did show metastases to this location. 3. 3. Sixteen of the twenty-nine patients had obvious groin metastases at the time of admission. Of the thirteen that appeared subsequently, eleven or 85 per cent appeared within the first two years of observation. 4. 4. The study of surgical specimens in this series tends to confirm two routes of spread from the anal region: (a) by the way of the perianal lymphatics or upper thigh directly to the superficial groin nodes, then to the iliac and obturator; (b) by way of the internal iliac or obturator nodes and then possibly to the superficial groin nodes. 5. 5. The route by which malignant celis are borne to the groins has little relation to the exact location of the primary lesion if the anal canal is involved, although the inferior route appeared more frequent in this group. 6. 6. Treatment of patients with groin metastases is not satisfactory as the three- and five-year survival rates are 16.0 and 12.5 per cent, respectively. However, it is not useless. 7. 7. Of seventeen patients in whom groin dissections were performed, nine died of their disease in less than three years, two died after five years, one died of other causes without evidence of disease and five are living free of disease two to six years. None of the patients having groin metastases present on admission is among those still alive. 8. 8. The presence of metastases to the deep pelvic nodes does not always mean a fatal outcome inasmuch as four of five patients who had obturator or iliac node metastases removed by radical groin dissection are living and free of evidence of their disease two to six years. 9. 9. If “prophylactic” groin dissections had been the practice in this series, fifty-three bilateral groin dissections would have been performed for the possible salvage of three patients who were not controlled by therapeutic groin dissection.