Groin Node Dissection Research Articles

Epidermoid carcinoma of the anus.

Twenty five patients with epidermoid carcinoma of the anus, representing 1.5% of all large bowel malignancies, were seen over a 33 year period. Most patients presented with an advanced lesion which gave rise to a fungating mass, bleeding or pain. Nearly all patients who received either palliative irradiation or refused treatment died within a year of diagnosis. Abdominoperineal resection in 12 patients yielded an encouraging five year survival rate of 68.5%. Therapeutic groin node dissection performed on six occasions led to only one late recurrence. The surgical literature on sphincter saving local excision and therapeutic radiotherapy is reviewed. Currently, radical resection remains the most appropriate treatment for the majority of patients with epidermoid anal cancer.

Cancer of the vulva: a review.

Localized carcinoma of the vulva in situ can be treated by wide local excision and continued close observation. Skinning vulvectomy, with or without subsequent skin grafting, is now well accepted as a treatment of Multifocal preinvasive disease. Microinvasive carcinoma of the vulva, on the other hand, is not treated with vulvectomy alone since the regional lymph nodes must be accurately assessed. The currently accepted treatment of invasive carcinoma of the vulva is radical vulvectomy and bilateral groin lymph node dissection. No longer is pelvic lymph node dissection to be considered a routine part of this therapy but is included only under specific circumstances. On rare occasion a more radical procedure such as anterior or posterior pelvic exenteration is considered appropriate therapy when the geographic location of the tumor requires this approach. The treatment of recurrent disease is influenced by its extent and location and must be tailored for the individual patient. Palliative vulvectomy is still used as a treatment of the far advanced disease in an attempt to improve personal and social hygiene, as well as to control serious infection and to prevent localized hemorrhage. The role of x-ray therapy in the treatment of carcinoma of the vulva is discussed.

Granular cell myoblastoma of the vulva

Granular cell myoblastoma is a rare tumor, generally benign, but also known to have a pleomorphic malignant variant. The gynecologist should be aware of this “innocuous” vulvar lesion which may also be located in other areas. Wide local excision is indicated for the benign form, but radical vulvectomy with bilateral groin and deep pelvic lymph node dissection is indicated for the malignant variant.

Surgical approach for treatment of epidermoid anal carcinoma.

The incidence of malignancy of the anus is rare when compared to colorectal cancer. At The New York Hospital-Cornell Medical Center 43 patients with anal cancer were seen since 1932. Five-year survival for patients treated by local excision, abdominal-perineal resecion, and abdominal perineal resection with associated inguinofemoral groin node dissection was 43%, 66%, and 33%, respectively. Therapy should be guided by location, size, and depth of the local lesion, as well as clinical node status. In general, local excision should be reserved for the most minute lesion. Groin dissection should be carried out when nodes are clinically diseased.

Pulmonary Allescheriasis

A llescheria boydii is a true fungus, being best known as a common causative agent of Madura foot in North America. 1,2 The fungus is a natural saprophyte that has been frequently isolated from the soil in various areas of the United States. 3-9 Only eight cases of patients with pulmonary involvement have previously been reported in the literature. 10-18 We report here the ninth case with a review of the literature. PATIENT SUMMARY A 59-year-old woman had had a left groin lymph node dissection at Ochsner Foundation Hospital for possible recurrence of a melanoma of the thigh. The original lesion had been removed by local excision 5% years previously. At the time of groin dissection, two of ten nodes were positive for melanoma. Chest roentgenograms at this time showed a nodule in the upper lobe of the right lung (Fig 1). Planigrams disclosed a cystic lesion approximately 2½ cm

Radical Surgery for Pelvic Malignancies

From June 1, 1961 to May 31, 1973, or a 12‐year period, we performed a total of 188 radical pelvic operations in the Department of Obstetrics and Gynecology of the Philippine General Hospital. Radical hysterectomy was done on 142 patients, pelvic exenteration on 16, radical vulvectomy and bilateral groin and pelvic node dissection on 27, and a combined radical vulvectomy and pelvic exenteration on 3. There were 157 patients with cancer of the cervix, 26 with cancer of the vulva, 3 with cancer of the vagina, and one each with cancer of the ovary and corpus uteri. Pelvic exenteration had the highest mortality and morbidity rates, followed by radical hysterectomy. There was no mortality in the radical vulvectomy group. The long‐term survival rate (3–12 years) with radical vulvectomy was 79%, with radical hysterectomy for cancer of the cervix, stage I was 72%, for stage H‐a, was 643%, and for recurrent cervical cancer was 36.8%. In the pelvic exenteration group, the long‐term survival rate (3–12 years) was 43.7%. Those patients who underwent a combined radical vulvectomy and pelvic exenteration had the lowest survival rate, 33.3%.