Abstract
Simple SummaryThis prospective study has demonstrated that if the inguinal nodes medial to the lateral border of the femoral artery and the femoral nodes are negative in patients with vulvar cancer, the chances of having a positive node lateral to the artery are less than 1 in 10,000. About one-third of groin nodes are situated lateral to the femoral artery, so leaving these nodes in situ if the medial nodes are negative should significantly decrease the incidence and severity of lower limb lymphedema, without compromising survival.Background: Lower limb lymphedema is a long-term complication of inguino-femoral lymphadenectomy and is related to the number of lymph nodes removed. Our hypothesis was that lymph nodes lateral to the femoral artery could be left in situ if the medial nodes were negative, thereby decreasing this risk. Methods: We included patients with vulvar cancer of any histological type, even if the cancer extended medially to involve the urethra, anus, or vagina. We excluded patients whose tumor extended (i) laterally onto the thigh, (ii) posteriorly onto the buttocks, or (iii) anteriorly onto the mons pubis. After resection, the inguinal nodes were divided into a medial and a lateral group, based on the lateral border of the femoral artery. Results: Between December 2010 and July 2018, 76 patients underwent some form of groin node dissection, and data were obtained from 112 groins. Approximately one-third of nodes were located lateral to the femoral artery. Positive groin nodes were found in 29 patients (38.2%). All patients with positive nodes had positive nodes medial to the femoral artery. Five patients (6.6%) had positive lateral inguinal nodes. The probability of having a positive lateral node given a negative medial node was estimated to be 0.00002. Conclusion: Provided the medial nodes are negative, medial inguino-femoral lymphadenectomy may suffice and should reduce lower limb lymphedema without compromising survival.
Highlights
Between December 2010 and July 2018, 76 patients underwent some form of groin node dissection, and data were obtained from 112 groins
The present study has demonstrated that the inguinal nodes medial to the lateral border of the femoral artery, together with the femoral nodes, which are medial to the femoral vein, are the first nodes involved in patients with vulvar cancer
We found a median of 6.8 nodes medial to the femoral artery, and 3.2 nodes laterally
Summary
The only way to be certain of the status of these nodes is to perform a complete inguino-femoral lymphadenectomy, but an inevitable consequence of this operation for many patients is lower limb lymphedema. Because it is a lifelong affliction, several attempts have been made to reduce the incidence of lymphedema over almost 50 years. Our hypothesis was that lymph nodes lateral to the femoral artery could be left in situ if the medial nodes were negative, thereby decreasing this risk.
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