Inguinal Lymphadenectomy For Penile Cancer Research Articles

Outcomes following radical inguinal lymphadenectomy for penile cancer using a fascial-sparing surgical technique.

To describe our surgical technique and report the oncological outcomes and complication rates using a fascial-sparing radical inguinal lymphadenectomy (RILND) technique for penile cancer patients with cN+ disease in the inguinal lymph nodes. Over a 10-year period, 660 fascial-sparing RILND procedures were performed in 421 patients across two specialist penile cancer centres. The technique used a subinguinal incision with an ellipse of skin excised over any palpable nodes. Identification and preservation of the Scarpa's and Camper's fascia was the first step. All superficial inguinal nodes were removed en bloc under this fascial layer with preservation of the subcutaneous veins and fascia lata. The saphenous vein was spared where possible. Patient characteristics, oncologic outcomes and perioperative morbidity were retrospectively collected and analysed. Kaplan-Meier curves estimated the cancer-specific survival (CSS) functions after the procedure. Median (interquartile range, IQR) follow-up was 28 (14-90) months. A median (IQR) number of 8.0 (6.5-10.5) nodes were removed per groin. A total of 153 postoperative complications (36.1%) occurred, including 50 conservatively managed wound infections (11.9%), 21 cases of deep wound dehiscence (5.0%), 104 cases of lymphoedema (24.7%), 3 cases of deep vein thrombosis (0.7%), 1 case of pulmonary embolism (0.2%), and 1 case of postoperative sepsis (0.2%). The 3-year CSS was 86% (95%Confidence Interval [95% CI] 77-96), 83% (95% CI 72-92), 58% (95% CI 51-66), respectively, for the pN1, pN2 and pN3 patients (p < 0.001), compared to a 3-year CSS of 87% (95% CI 84-95) for the pN0 patients. Fascial-sparing RILND offers excellent oncological outcomes whilst decreasing the morbidity rates. Patients with more advanced nodal involvement had poorer survival rates, emphasizing the need for adjuvant chemo-radiotherapy.

Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timing.

Few reports have investigated the oncologically safe timing of prophylactic inguinal lymphadenectomy for penile cancer patients with clinically normal inguinal lymph nodes (cN0), particularly those who received delayed surgical treatment. The study included pT1aG2, pT1b-3G1-3 cN0M0 patients with penile cancer who received prophylactic bilateral inguinal lymph nodes dissection (ILND) at the Department of Urology of Tangdu Hospital between October 2002 and August 2019. Patients who received simultaneous resection of primary tumor and inguinal lymph nodes were assigned to the immediate group, while the rest were assigned to the delayed group. The optimal timing of lymphadenectomy was determined based on the time-dependent ROC curves. The disease-specific survival (DSS) was estimated based on the Kaplan-Meier curve. Cox regression analysis was used to evaluate the associations between DSS and the timing of lymphadenectomy and tumor characteristics. The analyses were repeated after stabilized inverse probability of treatment weighting adjustment. A total of 87 patients were enrolled in the study, 35 of them in the immediate group and 52 in the delayed group. The median (range) interval time between primary tumor resection and ILND of the delayed group was 85 (29-225) days. Multivariable Cox analysis demonstrated that immediate lymphadenectomy was associated with a significant survival benefit (HR, 0.11; 95% CI, 0.02-0.57; p = 0.009). An index of 3.5 months was determined as the optimal cut-point for dichotomization in the delayed group. In high-risk patients who received delayed surgical treatment, prophylactic inguinal lymphadenectomy within 3.5 months was associated with a significantly better DSS compared to dissection after 3.5months (77.8% and 0%, respectively; log-rank p<0.001). Immediate and prophylactic inguinal lymphadenectomy in high-risk cN0 patients (pT1bG3 and all higher stage tumours) with penile cancer improves survival. For those patients at high risk who received delayed surgical treatment for any reason, within 3.5 months after resection of the primary tumor seems to be an oncologically safe window for prophylactic inguinal lymphadenectomy.

Single-position robot-assisted versus laparoscopic antegrade bilateral inguinal lymphadenectomy for penile cancer: A retrospective controlled study

ObjectivesThe main purpose of this study was to compare the surgical strategy and clinical outcomes of single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy for penile cancer. Materials and methods21 patients were diagnosis with squamous cell carcinoma and identified from March 2010 to December 2020 in our department. Ten patients were received single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy (robot-assisted group), and eleven patients underwent laparoscopic inguinal lymphadenectomy (laparoscopic group). Preoperative physical examination and related auxiliary examinations all indicated bilateral inguinal lymph node enlargement, and there was no distant metastasis patient presented during the follow-up period. ResultsThere was no intraoperative conversion to open surgery. The operation time under robot-assisted group was 104 ± 13 min which was significantly shorter than laparoscopic group (136 ± 11 min, P < 0.01). The average number of lymph nodes was 22.2 ± 4.5 of both sides in robot-assisted group, which was statistically different compared with laparoscopic group (15.4 ± 3.1, p < 0.01). Moreover, there was significant difference of hospitalization cost between two groups (CNY 67429 ± 5586 vs 28582 ± 3774, P < 0.01). No differences in operation time, blood loss, and length of stay were recorded. ConclusionsThe single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy reveals with shorter operating time, and better surgical effect, Moreover, we prefer to no change the trocars layout and mechanical arm system during the operation.

A0687 - Inguinal lymphadenectomy for penile cancer using a fascial sparing technique -outcomes from a single centre

A0687 - Inguinal lymphadenectomy for penile cancer using a fascial sparing technique -outcomes from a single centre

V20 - Robot-assisted video-endoscopic radical inguinal lymphadenectomy for penile cancer: surgical anatomy and technique

V20 - Robot-assisted video-endoscopic radical inguinal lymphadenectomy for penile cancer: surgical anatomy and technique

Radical Videoscopic Inguinal Lymphadenectomies: A Matched Pair Analysis.

To evaluate the modifications and feasibility of radical videoscopic inguinal lymphadenectomy (VIL). From January 2010 to December 2017, more than 200 patients who have underwent bilateral radical inguinal lymphadenectomy for penile cancer in Sun Yat-Sen University Cancer Center. And there were 33 patients who received radical VIL and 174 patients who received open inguinal lymphadenectomy (OIL). According to similar factors of age, body mass index, T stage, and N stage, two matched groups were created with a rate of 1:2, one group received VIL, and another group received OIL. The numbers of harvested lymph nodes, operating times, and complications were compared between the two groups. Descriptive statistical analyses, t tests, chi-square tests, and rank sum tests were performed. In total, 93 patients were selected, including 31 patients who underwent bilateral VIL and 62 who underwent OIL. The numbers of harvested lymph nodes did not differ significantly (p = 0.983), the operating time was longer for the VIL than the open lymphadenectomy (p < 0.01), and the morbidity was lower among the VIL than the open lymphadenectomy. Modified radical VIL is feasible, practical, and results in reduced morbidity. The dissecting field and the defined plane were critical to these modifications.

Lymph node yield as a predictor of overall survival following inguinal lymphadenectomy for penile cancer

ObjectiveTo determine whether a specific lymph node yield (LNY) affects overall survival (OS) in patients with penile cancer. Materials and MethodsUsing the National Cancer Database, we identified 364 men diagnosed with pSCC who underwent ILND between 2004 and 2013. Men diagnosed on autopsy or at the time of death, patients with preoperative chemotherapy or radiotherapy, M+ and N3 disease, or with less than 3-month of follow-up were excluded. Kaplan-Meier analysis was used to compare Overall Survival (OS). A multivariable Cox regression model was developed to assess predictors of OS. ResultsThe median number of LN retrieved was 16 (IQR: 9-23). There was no significant difference in race, stage, grade for men with LNY ≤15 vs. >15. However, men with LNY ≤15 were significantly older than those with LNY >15 (65 vs. 59 years, p<0.001). On multivariable analysis, radical surgery, age, N+ disease, and LNY ≤15 were independent predictors of worse OS. Patients with LNY ≤15 showed significantly worse 5-year OS versus those with LNY >15 (49% vs. 67%, p=0.008). Nodal density (ND) ≥12.5% was also associated with decreased 5-year OS versus ND <12.5% (31% vs. 70%, p<0.0001). ConclusionsLNY following ILND for pSCC appears to be an independent predictor of OS. A total LNY of >15 following ILND may have a beneficial impact on OS and serve as the threshold for defining an adequate ILND.

Robotic inguinal lymphadenectomy for penile cancer: the why, how, and what.

Squamous cell carcinoma of the penis (SCC-P) demonstrates a reliable pattern of spread to the lymph nodes of the groin. High grade and higher stage (pT1b or greater) SCC-P demonstrate a higher propensity for metastasis to the inguinal lymph nodes. Further, lymphadenopathy progresses in a predictable fashion, from superficial inguinal lymph nodes to deep inguinal lymph nodes to pelvic lymph nodes, with limited survival noted for those patients with progression to pelvic lymph nodes. Fortunately, inguinal lymphadenectomy can provide cure and improvement in RFS for SCC-P. Unfortunately open inguinal lymphadenectomy is associated with significant morbidity. Perhaps owing to this morbidity, inguinal lymphadenectomy is underperformed in the US. In other words, urologists only offer inguinal lymphadenectomy for high risk SCC-P in only a minority of cases and even when performed, lymph node yield is often unsatisfactory (less than 8 nodes per groin). Recently, a laparoendoscopic inguinal lymphadenectomy has been developed as a new approach to offer potentially curative lymph node resection while minimizing morbidity. The robotic platform has since been adapted for this approach and several reports demonstrate significant improvements in morbidity while maintaining oncologic equivalency. This review highlights the rationale for inguinal lymphadenectomy, inguinal lymph node anatomy, and technical considerations and outcomes of laparoscopic and robotic inguinal lymphadenectomy.

PD49-02 PREDICTION OF POSTOPERATIVE COMPLICATIONS AFTER INGUINAL LYMPHADENECTOMY FOR PENILE CANCER USING A NOVEL CLASSIFICATION TOOL

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2017PD49-02 PREDICTION OF POSTOPERATIVE COMPLICATIONS AFTER INGUINAL LYMPHADENECTOMY FOR PENILE CANCER USING A NOVEL CLASSIFICATION TOOL Yao Zhu, Wei-Jie Gu, Philippe Spiess, and Ding-Wei Ye Yao ZhuYao Zhu More articles by this author , Wei-Jie GuWei-Jie Gu More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , and Ding-Wei YeDing-Wei Ye More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2226AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To develop and validate a preoperative radiological assessment tool for predicting complications following inguinal lymph node dissection (ILND) in penile cancer patients. METHODS Patients treated at Fudan University Shanghai Cancer Center (n=175) and Moffitt Cancer Center (n=28) were used for prediction assessment and repetition, respectively. The ILN complexity score (ILCS) included 5 radiological features of ILNs and surrounding adipose tissue. A tertiary (low/moderate/high) classification was assigned according to the sum score. Postoperative complications were graded according to the Clavien-Dindo system. Logistic regression analyses were used to assess the odd ratios (ORs) of the ILCS for predicting overall and major (grade=2) complications. RESULTS In the primary cohort, overall and major complications were observed in 47.4% and 20.5% of patients, respectively. Controlling for covariates, the moderate and high scores had 2.73 (p=0.02) and 4.61-fold (p=0.01) increased risks of overall complications compared with the low score. For predicting major complications, the adjusted OR was 3.48 for the moderate score (p=0.02), and 17.01 for the high score (p<0.01), using the low score as a reference. The predictive accuracy of the ILCS for overall and major complications was 0.63 (0.56-0.70) and 0.73 (0.64-0.82), respectively. In the repetition cohort, the ILCS was significantly associated with major complications (OR=17.33, p=0.02) and showed a predictive accuracy of 0.79 (0.64-0.93). CONCLUSIONS Using structured radiological measurements of the inguinal nodal basin, the ILCS provided accurate risk estimation of overall and major complications after ILND for penile cancer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e973-e974 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yao Zhu More articles by this author Wei-Jie Gu More articles by this author Philippe Spiess More articles by this author Ding-Wei Ye More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

714 - Prediction of postoperative complications after inguinal lymphadenectomy for penile cancer using a novel classification tool

714 - Prediction of postoperative complications after inguinal lymphadenectomy for penile cancer using a novel classification tool

59 Endoscopic inguinal lymphadenectomy for penile cancer: Long-term follow-up

59 Endoscopic inguinal lymphadenectomy for penile cancer: Long-term follow-up

Robotic Bilateral Inguinal Lymphadenectomy in Penile Cancer, Development of a Technique Without Robot Repositioning: A Case Report

Abstract Introduction: Inguinal lymphadenectomy is the treatment of choice for patients with penile cancer and inguinal lymph node metastases. We describe the performance of robotic bilateral ingui...

Fascia Lata Preservation During Inguinal Lymphadenectomy for Penile Cancer: Rationale and Outcome

To investigate local groin recurrence and morbidity associated with fascia lata preservation during inguinal lymphadenectomy (LAD) for penile carcinoma. Between January 2002 and December 2011, 201 inguinal dissections with preservation of the fascia lata were performed in 104 patients with clinical disease staged at ≤N2. The dissection boundaries were the same as those for radical inguinal LAD. All superficial inguinal nodes were removed en bloc. The cribriform fascia near the femoral canal was divided, and the deep inguinal lymph nodes were dissected. The fascia lata was completely preserved and sutured to the subcutaneous tissue. Sartorius muscle transposition was eliminated. Survival and morbidity data were retrospectively analyzed, and survival probabilities were calculated. The median operative time for unilateral inguinal LAD was 45 minutes (range, 40-60 minutes). Median follow-up was 36 months (range, 10-130 months). A mean number of 12.5 nodes were removed per groin. One patient (1%) had a recurrence outside the borders of the fascia lata after 7 months of follow-up. The 3-year disease-free survival rate was 92.1% (100% for pN0, 91.3% for pN1, 80% for pN2, and 33.3% for pN3 disease). A total of 59 complications (29.3%) occurred, including wound infection (2.5%), skin necrosis (5.5%), lymphedema (11.8%), seroma formation (1.5%), lymphocele (5%), paresthesia (3.5%), and deep venous thrombosis (0.5%). Inguinal dissections with preservation of the fascia lata for penile carcinoma patients without extranodal extension is as effective as the classic dissection technique but decreases complications related to groin dissection.

Phase 1 prospective evaluation of the oncological adequacy of robotic assisted video‐endoscopic inguinal lymphadenectomy in patients with penile carcinoma

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Several lymph node staging strategies have been proposed as a response to the high morbidity seen after standard inguinal lymphadenectomy for penile cancer. A video-endoscopic (laparoscopic and robotic) approach has been proposed as a less morbid procedure in several retrospective studies. To date, none has evaluated the oncological adequacy with regard to whether all relevant nodes have been removed. To the authors' knowledge this is the first prospective study of a robotic or laparoscopic inguinal lymphadenectomy that evaluates the oncological adequacy of this approach for penile cancer. The study shows that robotic inguinal lymphadenectomy allowed adequate staging of disease in the inguinal region by removing all relevant lymph nodes as assessed by an independent evaluating urological oncologist. To prospectively determine the oncological adequacy of robotic assisted video-endoscopic inguinal lymphadenectomy (RAVEIL). Patients with T1-3N0 penile cancer were enrolled into a prospective phase I trial at a tertiary care institution from March 2010 to January 2012. All patients underwent an initial RAVEIL approach. Verification of adequacy of dissection was performed by an independent surgeon via a separate open incision at the conclusion of the RAVEIL procedure. Out of 10 patients, if more than two superficial inguinal fields with ≥2 nodes or more than four with ≥1 node remained within the superficial dissection field, the study would not proceed to phase II. Of 10 enrolled patients two had inguinal metastases and all positive nodes were detected by RAVEIL. The remaining eight patients had no metastases, with a mean of nine (range 5-21) left and nine (range 6-17) right nodes removed. One inguinal field RAVEIL was converted to an open dissection. The verifying surgeon confirmed that 18 of 19 inguinal fields (94.7% in nine patients) had an adequate dissection. Two benign nodes were found just beneath Scarpa's fascia above the inguinal dissection field. Limitations of the study include an inability to determine decisively what specific wound complications were related to RAVEIL because of the protocol-specified creation of a small inguinal incision for verification of adequate dissection. RAVEIL allowed adequate staging of disease in the inguinal region among patients with penile cancer at risk for inguinal metastases.

Early Wound Complications After Inguinal Lymphadenectomy in Penile Cancer: A Historical Cohort Study and Risk-factor Analysis

BackgroundComplication rates after inguinal lymph node dissection (ILND) are high. Risk factors for early wound complications after ILND in patients with penile carcinoma have not yet been studied. ObjectivesTo assess the frequency of early wound complications in a contemporary series and to identify clinical risk factors for early wound complications after ILND for penile carcinoma. Design, setting, and participantsWe evaluated 237 ILNDs in 163 patients with penile cancer treated between 2003 and 2012 at the Netherlands Cancer Institute. Outcome measurements and statistical analysisWe assessed the occurrence of wound infection, skin-flap problems, and seroma formation and graded complications using the modified Clavien system. Univariable and multivariable penalised mixed effects logistic regression was used to identify clinical risk factors for occurrence of any complication (grade ≥1) and of moderate to severe complications (grade ≥2). Results and limitationsOne complication or more occurred in 58% of the procedures, and 10% of those complications were severe. Wound infection occurred in 43%, seroma formation occurred in 24%, and skin-flap problems occurred in 16%.Palpable disease was the only factor associated with grade ≥1 complications in the univariable analysis (odds ratio [OR]: 0.43; p=0.02). In the multivariable model, after penalisation, no statistically significant risk factors remained.Univariable associations for grade ≥2 complications were present for body mass index (BMI; OR of 1.66 for a 5.8-point change in BMI; p=0.05) and sartorius muscle transposition (OR: 2.64; p=0.04). In the reduced multivariable model, the OR for sartorius muscle transposition was 2.12 (p=0.06) and for BMI was 1.76 (p=0.03). In addition, bilateral dissection approached significance in the multivariable model (OR: 2.17; p=0.06). This study is limited by its observational nature. ConclusionsWound complication rates after ILND are high in this cohort. BMI, sartorius muscle transposition, and bilateral dissection were the factors most strongly associated with the occurrence of grade ≥2 wound complications.

387 Surgical complications after inguinal lymphadenectomy in penile cancer – an explorative historical cohort study for risk factors

387 Surgical complications after inguinal lymphadenectomy in penile cancer – an explorative historical cohort study for risk factors

Therapeutic Strategies in Penile Cancer: State of the Art

A systematic review of the current treatment options and of the outcomes of penile carcinoma has been performed with special focus on controversial issues. A MedLine search using specified search terms was done during the period 1988 - January 2013. Demolitive surgery is considered as the "gold standard" treatment of invasive penile carcinoma staged higher than T2, but negative psychological outcomes were reported. On the other hand, conservative surgical techniques have been associated with higher recurrence rates. Potency-sparing technique (glansectomy and apexes sparing) preserves penile length: the reconstruction of glans anatomy and function is a key point to restore anatomy and sexual functions. Techniques such as glanduloplasty have given satisfactory anatomic, functional and sexual outcomes. Lymphadenectomy is indicated in any case of inguinal palpable nodes that persist after a course of antibiotic therapy, but also in all the cases staged T2 or higher, or in any high-grade penile cancer. It is still being debated the extension of inguinal lymphadenectomy for penile cancer: unilateral, bilateral, and extended to pelvic lymph nodes. Due to the specific radioresistance of penile cancer, radiation therapy is currently indicated in case of unresectable penile cancers with palliative intent. Chemotherapy is indicated as adjuvant therapy for stage T1-T3, N1-3, M0, or as neo-adjuvant therapy in the event of extensive pelvic and inguinal lymphadenopathies, or as palliative treatment in patients with unresectable or metastatic cancers. New chemotherapy agents such as Cis - platinum and Taxanes have shown promising results in early trials.

Vacuum-assisted Closure versus Conventional Wound Care in the Treatment of Wound Failures Following Inguinal Lymphadenectomy for Penile Cancer: A Retrospective Study

ObjectivesImpaired wound healing is a frequent event in inguinal surgery and very common after lymphadenectomy for penile cancer. Although vacuum therapy has been reported to expedite the healing of complex wound failures, vacuum-assisted closure (VAC) has been reported to be contraindicated in malignancy. In the present study we evaluated the use of VAC in the treatment of complex wound failures following inguinal lymphadenectomy for penile cancer in comparison to conventional wound care (CWC) implying debridement and saline-soaked gauze. MethodsWe retrospectively identified six inguinal wounds following inguinal lymphadenectomy for penile cancer and subsequent use of VAC from 2003 to 2006 at our institution. Data on surgical interventions, complications, length of time required for closure, and outcome were compared to 10 inguinal defects treated with CWC between 2000 and 2003. ResultsWound volume was comparable for both groups. Wound breakdown occurred at a median of 7.4 d after inguinal lymphadenectomy and was treated by CWC for a mean of 69.8 d. In the VAC group, the median duration until complete closure was 38.9 d. Thus, VAC was shown to result in complete wound healing in less time (p<0.001). No local recurrence in the VAC group was noted despite positive lymph nodes. ConclusionsVAC therapy is effective in complex inguinal wound failures following lymphadenectomy for penile cancer and appears to be superior to CWC. VAC seems to offer adequate safety concerning local recurrence.

Morbidity of modified prophylactic inguinal lymphadenectomy for squamous cell carcinoma of the penis.

Classic inguinal lymphadenectomy for penile cancer is associated with significant immediate and long-term sequelae limiting its use in the prophylactic setting. Preservation of the saphenous vein has been shown in the gynecological oncology literature to reduce the morbidity of inguinal lymphadenectomy. In addition, saphenous vein sparing coupled with thick skin flaps and limited lymphadenectomy for penile cancer has been associated with minimal morbidity. Reports on saphenous vein preservation in men undergoing inguinal lymphadenectomy are limited and, therefore, we reviewed our experience. We reviewed retrospectively 11 patients with stage pT1-T3 cN0 M0 grades I to III carcinoma of the penis or penile urethra who underwent bilateral inguinal lymphadenectomy with saphenous vein sparing and thick skin flaps between August 1995 and November 2001. Of the patients 1 underwent simultaneous penectomy and 10 had undergone a partial or total penectomy previously. Short-term and long-term postoperative complications were defined as minor-did not require significant medical intervention and included superficial skin edge sloughing, seroma and lymphocele, and major-skin edge or flap necrosis, wound infection, deep venous thrombosis or leg edema inhibiting return to pretreatment activities. Mean followup was 9 months. The saphenous vein was preserved in 19 groins and ligated in 3. Simultaneous bilateral pelvic lymphadenectomy was performed in 5 patients. Nodal disease was found in 5 of 11 (45%) patients on pathological review. Minor short-term complications occurred in 8 of 22 (36%) groins, and major complications included deep venous thrombosis in 1 case and a small myocardial infarction in 1. There was no perioperative mortality. Lower extremity lymphedema requiring more than temporary (less than 6 months) support hose management did not occur in any patient. There were no inguinal recurrences during followup. Inguinal lymphadenectomy with saphenous vein sparing and thick skin flaps appears to offer excellent functional outcome in patients undergoing prophylactic bilateral inguinal lymphadenectomy for high risk disease. Early followup indicates that the local recurrence rate does not appear to increase compared to similar patients reported on in the literature treated with the classic dissection technique.

Primary skin closure of large groin defects after inguinal lymphadenectomy for penile cancer using an abdominal cutaneous advancement flap.

PURPOSE Large groin defects may be created after inguinal lymphadenectomy for bulky metastatic penile cancer. We describe a new method of primary closure of a large groin skin defect. MATERIALS AND METHODS In 3 patients with large volume inguinal lymph node metastases with skin breakdown and secondary infection extensive inguinal lymphadenectomy was done with wide surgical excision of skin and subcutaneous tissue. The procedures resulted in a large groin defect. Sartorius muscle was transferred to cover the femoral vessels. An abdominal advancement cutaneous flap was placed for soft tissue and skin coverage of the wound. RESULTS Primary closure of a large skin defect was possible using an abdominal advancement flap. In all patients the wound healed primarily with good cosmesis. A single patient underwent postoperative external beam radiation therapy to the flap site with no untoward effect on graft survival. CONCLUSIONS Large groin skin defects can be closed primarily using an abdominal advancement flap. This technique may also be used for bilateral groin defects. Compared with other types of flaps advocated for this purpose the main advantages of the procedure are simplicity, lower morbidity and superior cosmetic results.