Groin Lymphadenectomy

This chapter discusses groin lymphadenectomy, citing the cases of two women whose clinical and MRI assessment of groin region neither showed enlarged groin nodes nor lymphadenopathy. The inguinal and femoral nodes are the sites of regional spread from vulval cancer, and appropriate groin lymphadenectomy is the single most important factor in reducing mortality from this cancer. Overall, 30% of patients with vulval cancer are diagnosed with metastatic disease to the inguinal or pelvic lymph nodes. MRI scan should be performed prior to surgery, and should include pelvic lymph nodes. When treating vulval cancers, both superficial and deep nodes are to be removed, because selective superficial inguinal lymphadenectomy constitutes undertreatment with a risk of nodal recurrence in 5% of patients before central recurrence. The mortality rate in these patients is high. Detecting vulval cancers in early stages can reduce the need for lymphadenectomy and related sequelae.