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Technique for inguino-femoral lymph node dissection in vulvar cancer: an international survey
  1. Sadie Esme Fleur Jones1,2,
  2. Pedro T Ramirez3,
  3. Geetu Prakash Bhandoria4,
  4. Heng-Cheng Hsu5,
  5. Navya Nair6,
  6. Florencia Noll7,
  7. Christopher N Hurt8,
  8. Robert Howells2,
  9. Kenneth Lim2 and
  10. Aarti Sharma2
  1. 1 School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK
  2. 2 Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
  3. 3 Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 Obstetrics and Gynaecology, Command Hospital, Bangalore, India
  5. 5 Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
  6. 6 Louisiana State University School of Medicine in New Orleans, New Orleans, Louisiana, USA
  7. 7 Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  8. 8 Wales Cancer Trials Unit, Cardiff University, Cardiff, South Glamorgan, UK
  1. Correspondence to Dr Sadie Esme Fleur Jones, School of Medicine, Cardiff University, Cardiff CF14 4XW, UK; jonessef{at}


Background Vulvar cancer is a rare disease and despite broad adoption of sentinel lymph node mapping to assess groin metastases, inguino-femoral lymph node dissection still plays a role in the management of this disease. Inguino-femoral lymph node dissection is associated with high morbidity, and limited research exists to guide the best surgical approach.

Objective To determine international practice patterns in key aspects of the inguino-femoral lymph node dissection technique and provide data to guide future research.

Methods A survey addressing six key domains of practice patterns in performing inguino-femoral lymph node dissection was distributed internationally to gynecologic oncology surgeons between April and October 2020. The survey was distributed using the British Gynecological Cancer Society, the Society of Gynecologic Oncology, authors' direct links, the UK Audit and Research in Gynecology Oncology group, and Twitter.

Results A total of 259 responses were received from 18 countries. The majority (236/259, 91.1%) of respondents reported performing a modified oblique incision, routinely dissecting the superficial and deep inguino-femoral lymph nodes (137/185, 74.1%) with sparing of the saphenous vein (227/258, 88%). Most respondents did not routinely use compression dressings/underwear (169/252 (67.1%), used prophylactic antibiotics at the time of surgery only (167/257, 65%), and closed the skin with sutures (192 74.4%). Also, a drain is placed at the time of surgery by 243/259 (93.8%) surgeons, with most practitioners (144/243, 59.3%) waiting for drainage to be less than 30–50 mL in 24 hours before removal; most respondents (66.3%) routinely discharge patients with drain(s) in situ.

Conclusion Our study showed that most surgeons perform a modified oblique incision, dissect the superficial and deep inguino-femoral lymph nodes, and spare the saphenous vein when performing groin lymphadenectomy. This survey has demonstrated significant variability in inguino-femoral lymph node dissection in cases of vulvar cancer among gynecologic oncology surgeons internationally.

  • vulvar and vaginal cancer
  • surgical oncology
  • lymph nodes

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @drsadiejones, @pedroramirezMD, @Bhandoria, @HsuMd

  • Collaborators The British Gynaecological Cancer Society (BGCS)The UK Audit and Research group in Gynaecological Oncology (ARGO)

  • Contributors All authors have contributed to this manuscript. SEFJ was responsible for study design, survey distribution, and writing the manuscript. AS helped with study design and survey distribution. PTR helped with designing and editing the final manuscript. GPB, H-CH, NN, and FN were responsible for survey distribution and helped with editing the final manuscript. CNH was responsible for the statistical analysis. KL and RH help with survey design.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.