Groin lymphadenectomy with Preservation of Femoral Fascia: Total Inguinofemoral Node Dissection for Treatment of Vulvar Carcinoma

Abstract

This article describes a new technique for groin lymphadenectomy with preservation of the femoral fascia based on correct embryologic and anatomic knowledge of inguinofemoral lymph node disposition and their exact relation with the fascial structures of Scarpa's triangle. Scarpa's triangle dissection follows a three-step procedure: development of the side starting from the inguinal ligament; development of the angles proceeding from the apex where the saphenous vein is resected; and dissection of the fossa ovalis by grasping and elevating the entire block of adipose tissue containing the superficial inguinofemoral nodes and the stump of the great saphenous vein. This surgical step allows us to expose and remove en bloc the deep femoral nodes lying medial to the portion of the femoral vein located within the fossa ovalis. The total number of inguinofemoral nodes removed from a series of 156 patients operated on during 1981-2002 ranged from 8 to 35 (mean 20) bilaterally and from 4 to 18 (mean 10) unilaterally. The 5-year survivals by stage were, respectively, 86.2% for stage Ib, 69.2% for stage II, 49.3% for stage III, and 13.3% for stage IVa; these figures are comparable to the survival rates reported by those performing the classic groin lymphadenectomy. Groin lymphadenectomy with preservation of the femoral fascia is thus an oncologically sound conservative procedure that can replace the classic Way's technique, which involves femoral vessel skeletonization, and can be useful for treating malignant diseases requiring groin dissection.

Number of Nodes Removed With Inguinofemoral Lymphadenectomy and Risk of Isolated Groin Recurrence in Women With FIGO Stage IB-II Squamous Cell Vulvar Cancer

“…Moreover, an appropriate groin node dissection is considered the greatest single factor in reducing the mortality from vulvar cancer. 2 To date, the groin dissection with preservation of femoral fascia 11,12 is the most commonly used procedure for radical inguinofemoral lymphadenectomy in women with vulvar SCC. Data are expressed as mean T SD or n (%) as appropriate.…”

“…1Y3 The anatomical boundaries of such a dissection are widely described elsewhere, 11,12 and the inguinofemoral lymphadenectomy with preservation of femoral fascia has become a standardized and widely used surgical technique.…”

“…Consensual bilateral groin lymphadenectomy (with the removal of both superficial inguinal nodes and deep femoral nodes), according to the standardized surgical technique of preservation of femoral fascia, 11,12 was adopted. In selected cases with a single lateralized tumor, only an ipsilateral lymphadenectomy was performed.…”

Video endoscopic-assisted inguino-femoral lymphadenectomy (VEIL) in squamous cell invasive vulvar carcinoma: our initial experience

“…Inguinal lymphadenectomy is a challenging surgical procedure with a high complication rate even for skilled surgeons and in the most recent series [9,21,22]. This can be related to the devascularization of skin flaps, the disruption of lymphatic afferents, concomitant medical conditions that predispose to poor wound healing, and simultaneous septic operative steps as ablation of a potential necrotic and infected primary tumor.…”

Lymphadenektomie der Leisten- und Beckenregion

“…So kann inguinal nur die oberflächliche Lymphknotengruppe entfernt werden, was zwar eine Reduktion der assoziierten Komplikationen bedeutet, allerdings mit dem Risiko von belassenen befallenen Lymphknoten in der unresezierten tiefen inguinalen Loge [12]. [20].…”