Introduction/Background Autopsy studies report inguinal metastasis in up to 3% of patients with advanced ovarian cancer. Metastasis occurs via a minor lymphatic drainage pathway running through the round ligament of the uterus toward the inguinal region. Postoperative complications after inguinal surgery performed through an incision crossing over Scarpa´s triangle extending to the anterior superior iliac spine, are common (seroma/lymphocele 6–40%, dehiscence 17–65%, infection 6–20%, lymphoedema 22–80%), debilitating and harbour considerable socioeconomic costs. To reduce surgical morbidity, an alternative approach per abdomen has been proposed in patients with ovarian cancer with metastatic inguinal lymphadenopathy.
Methodology A fifty-four year old woman underwent primary cytoreductive surgery for histologically proven metastatic high grade serous carcinoma of tubo-ovarian origin. CT/MRI had revealed bilateral inguinal lymphadenopathy with a 16 mm right external iliac lymph node (FIGO stage IVB). Surgery involved a midline-laparotomy, total omentectomy, enbloc resection of appendix/recto-sigmoid/uterus/cervix/both tubes and ovaries/pelvic peritoneum and excision of enlarged right external iliac lymph node and enlarged bilateral inguinal nodes. R0 resection achieved.
Using an abdominal approach, Scarpa´s fascia was identified and the nodal bundle dissected from inferior surface of Scarpa. External oblique fascia identified and nodal tissue dissected, preserving the long saphenous vein. Nodal tissue removed within femoral triangle medial to femoral artery and vein with inguinal ligament superiorly.
Results Operative time was 12 minutes per side. Drain anterior to rectus sheath was removed on the seventh postoperative day. No postoperative complications were observed. Histology confirmed bilateral tumour infiltration in the inguinal nodes which measured 35 x 15 x 12 mm on the left and 55 x 30 x 20 mm on the right.
Conclusion An abdominal approach to inguinal node dissection in metastatic ovarian cancer has the potential to reduce surgical morbidity and reduce operating time when compared to the standard approach without compromising complete cytoreduction.
Disclosure FG, AF, AL, EB, ARJ, SP declare no conflict of interest. RM declares research funding from The Eve Appeal and Cancer Research UK into population testing and from Barts & the London Charity and Rose Trees Trust outside this work, an honorarium for grant review from Israel National Institute for Health Policy Research and honorarium for advisory board membership from Astrazeneca/MSD. RM is supported by an NHS Innovation Accelerator (NIA) Fellowship for population testing.
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