Clinical Review

Surgical management of metastatic inguinal lymphadenopathy

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7477.1272 (Published 25 November 2004) Cite this as: BMJ 2004;329:1272
  1. Marc C Swan, Royal College of Surgeons of England surgical research fellow (marc.swan@surgery.oxford.ac.uk)1,
  2. Dominic Furniss, Wellcome Trust clinical research training fellow1,
  3. Oliver C S Cassell, consultant surgeon1
  1. 1 Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, Oxford OX2 6HE
  1. Correspondence to: M C Swan
  • Accepted 5 October 2004

Introduction

Inguinal lymphadenectomy, or groin dissection, has a key role in the management of patients with penile, vulval, anal, and cutaneous malignancy. About 500 procedures are performed in the United Kingdom each year by general, gynaecological, plastic, and urological surgeons. Groin dissection is associated with high postoperative morbidity, chiefly related to wound healing and lymphoedema. As the preoperative diagnosis and postoperative care of these patients may also involve general practitioners, oncologists, dermatologists, and specialist nurses, this review is aimed at providing a concise yet comprehensive summary of the key aspects of managing inguinal lymph nodes.

Methods

We searched the Cochrane Library and Medline online databases, using the terms “inguinal lymphadenectomy”, “groin dissection”, and “sentinel lymph node biopsy”, combined with “melanoma”, or “carcinoma” and either “vulva”, “penis”, or “anus”. We reviewed abstracts and selected relevant articles.

Pathology

Tumours of the male genital tract

Squamous cell carcinoma is the most common tumour of the penis (table 1, accounting for 95% of primary penile malignancies.w1 Relatively uncommon in developed countries, it accounts for up to 17% of all male malignancies in developing countries.1 2 Penile malignancy affects about 800 men per annum in the United Kingdom.1 The mean age of affected individuals is 64.1 Palpable inguinal lymphadenopathy at presentation may represent metastatic disease or secondary inflammation, so a four to six week course of oral antibiotics is usually prescribed, followed by re-evaluation of the lymphadenopathy. However, studies have shown that up to 20% of patients with no palpable lymphadenopathy will have nodal metastasis.w2

View this table:
Table 1

Pathology of tumours commonly metastasising to the inguinal lymph nodes

Tumours of the female genital tract

Tumours arising from the vulva and lower third of the vagina metastasise to the inguinal lymph nodes. Vaginal tumours are rare and will not be considered further here. Squamous cell carcinoma is the most common tumour of the vulva (table 1), and 1996 …

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