An anatomical study of inguinal lymph node topography and clinical implications for the surgical management of vulval cancer.

There is significant morbidity associated with inguinofemoral lymphadenectomy in the surgical treatment of vulval cancer, but surgical removal of all involved lymph nodes is integral to the treatment of the disease. In order to examine the feasibility of limiting the surgical dissection of the groin without compromising the removal of all lymph nodes, a study was undertaken to determine the exact location of the inguinal lymph nodes. Bilateral lower limb lymphangiograms from 73 patients were analyzed to determine the location of the most laterally occurring lymph node relative to the anterior superior iliac spine (ASIS) and the most medial node relative to the pubic tubercle (PT). By conserving the lateral 15% of fibro-fatty tissue overlying the right inguinal ligament and the lateral 20% over the left inguinal ligament, there is statistically a greater than 99.8% chance of complete nodal clearance. The anatomical basis for a more conservative inguinofemoral dissection is provided that may decrease surgical morbidity without compromising survival.