Inguinofemoral lymphadenectomy: randomized trial comparing inguinal skin access above or below the inguinal ligament.
BACKGROUND
Groin wound breakdown, lymphoceles, cellulitis, and chronic leg edema are the most frequent complications of inguinal lymphadenectomy, resulting in severe patient discomfort and significant lengthening of postoperative stay. Despite all innovations, complication rates are still high and inevitable. Our experience suggests that cutaneous flap preparation, identification of the Camper fascia, and preservation of the most lateral lymphatics decrease associated morbidity. The aim of this study is to analyze whether different cutaneous skin flap preparations and their different devascularization (above or below the inguinal ligament), resecting all the lymphofatty tissue, reduce groin wound complications, and whether the same therapeutic approach and number of lymph nodes removed are comparable.


METHODS
This prospective randomized clinical trial of 62 consecutive patients affected by vulvar carcinoma requiring inguinal lymphadenectomy compared skin inguinal incision carried out 3-4 cm above the inguinal ligament (group A) or below it (group B).


RESULTS
Inguinal dehiscence was present in 17 of 53 (32.1%) patients in group B and in 9 of 54 (16.7%) in group A (P=0.10). Lymphocele was observed in 10 of 53 lymphadenectomies (18.9%) in group B and in 3 of 54 dissections (5.6%) in group A (P=0.07). Upper incision allows more precise identification of the Camper fascia, is less painful, and gives better cosmetic results. Moreover, there may be advantage, albeit not statistically significant, regarding flap length, wound dehiscence rate, and speed of wound healing. There was no difference in chronic leg edema, number of nodes removed, or hospital stay.
Manci
Natalina
N
Department of Gynecology, Obstetrics and Perinatology, University of Rome La Sapienza, 00161 Rome, Italy. natalina.manci@uniroma1.it
Marchetti
Claudia
C
Esposito
Francesca
F
De Falco
Carmen
C
Bellati
Filippo
F
Giorgini
Margherita
M
Angioli
Roberto
R
Panici
Pierluigi Benedetti
PB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006119:Groin / Q000473:pathology / Q000601:surgery; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012501:Saphenous Vein / Q000601:surgery; D012867:Skin / Q000294:innervation*; D013524:Surgical Flaps; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*