In general, 20-30% of patients with positive inguinal nodes have positive pelvic nodes.1,4,22 Although patients with pelvic lymphadenopathy are considered to have a bleak outcome, pelvic lymphadenectomy can be curative in some patients. In particular, those patients with occult pelvic metastases may benefit. Several authors have shown that the likelihood of pelvic nodal involvement is related to the number of positive nodes in the inguinal specimen and presence of extranodal extension.1-7,22 Patients with one intranodal inguinal metastasis have a very low probability of pelvic node involvement (<5%, unpublished data).4,22 At the authors' institute a pelvic dissection is considered unnecessary in these patients. In all other patients with two or more inguinal nodes involved or extranodal extension an ipsilateral pelvic lymph-adenectomy of the affected side is performed. There is ample clinical and published evidence that cross-over from the groin to the contralateral pelvic area does not occur.4,22,65 Therefore, contralateral pelvic lymphadenectomy is not recommended in patients with unilateral nodal involvement. Patients with preoperative evidence of pelvic metastases are unlikely to be cured by surgery alone and are candidates for neoadjuvant chemotherapy before undergoing surgery (Fig. 9.5).
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