Hacker Neville F, Barlow Ellen, Morrell Stephen, Tang Katrina
Gynaecological Cancer Centre, Royal Hospital for Women, Sydney 2031, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney 2033, Australia.
Cancers (Basel). 2021 Nov 19;13(22):5806. doi: 10.3390/cancers13225806.
Lower limb lymphedema is a long-term complication of inguino-femoral lymphadenectomy and is related to the number of lymph nodes removed. Our hypothesis was that lymph nodes lateral to the femoral artery could be left in situ if the medial nodes were negative, thereby decreasing this risk.
We included patients with vulvar cancer of any histological type, even if the cancer extended medially to involve the urethra, anus, or vagina. We excluded patients whose tumor extended (i) laterally onto the thigh, (ii) posteriorly onto the buttocks, or (iii) anteriorly onto the mons pubis. After resection, the inguinal nodes were divided into a medial and a lateral group, based on the lateral border of the femoral artery.
Between December 2010 and July 2018, 76 patients underwent some form of groin node dissection, and data were obtained from 112 groins. Approximately one-third of nodes were located lateral to the femoral artery. Positive groin nodes were found in 29 patients (38.2%). All patients with positive nodes had positive nodes medial to the femoral artery. Five patients (6.6%) had positive lateral inguinal nodes. The probability of having a positive lateral node given a negative medial node was estimated to be 0.00002.
Provided the medial nodes are negative, medial inguino-femoral lymphadenectomy may suffice and should reduce lower limb lymphedema without compromising survival.
下肢淋巴水肿是腹股沟股淋巴结清扫术的一种长期并发症，且与切除的淋巴结数量有关。我们的假设是，如果内侧淋巴结为阴性，则股动脉外侧的淋巴结可以原位保留，从而降低这种风险。
我们纳入了任何组织学类型的外阴癌患者，即使癌症向内扩展累及尿道、肛门或阴道。我们排除了肿瘤向（i）外侧扩展至大腿、（ii）后侧扩展至臀部或（iii）前侧扩展至阴阜的患者。切除后，根据股动脉的外侧边界将腹股沟淋巴结分为内侧组和外侧组。
在2010年12月至2018年7月期间，76例患者接受了某种形式的腹股沟淋巴结清扫术，并从112个腹股沟获取了数据。大约三分之一的淋巴结位于股动脉外侧。29例患者（38.2%）发现腹股沟淋巴结阳性。所有淋巴结阳性的患者，其股动脉内侧的淋巴结均为阳性。5例患者（6.6%）腹股沟外侧淋巴结阳性。在内侧淋巴结为阴性的情况下，外侧淋巴结阳性的概率估计为0.00002。
如果内侧淋巴结为阴性，内侧腹股沟股淋巴结清扫术可能就足够了，并且应该能减少下肢淋巴水肿而不影响生存率。
