AN ANATOMICAL STUDY OF INGUINAL LYMPH-NODE TOPOGRAPHY AND CLINICAL IMPLICATIONS FOR THE SURGICAL-MANAGEMENT OF VULVAR CANCER

There is significant morbidity associated with inguinofemoral lymphade nectomy in the surgical treatment of vulval cancer, but surgical remov al of all involved lymph nodes is integral to the treatment of the dis ease. In order to examine the feasibility of limiting the surgical dis section of the groin without compromising the removal of all lymph nod es, a study was undertaken to determine the exact location of the ingu inal lymph nodes. Bilateral lower limb lymphangiograms from 73 patient s were analyzed to determine the location of the most laterally occurr ing lymph node relative to the anterior superior iliac spine (ASIS) an d the most medial node relative to the pubic tubercle (PT). By conserv ing the lateral 15% of fibro-fatty tissue overlying the right inguinal ligament and the lateral 20% over the left inguinal ligament, there i s statistically a greater than 99.8% chance of complete nodal clearanc e. The anatomical basis for a more conservative inguinofemoral dissect ion is provided that may decrease surgical morbidity without compromis ing survival.