Indications for Therapeutic Lymphadenectomy 971 Indication for Inguinal Lymphadenectomy

Ipsilateral inguinal lymphadenectomy is indicated when tumor-bearing lymph nodes are found with sentinel node biopsy, FNAC, or excision biopsy. Should a bilateral inguinal dissection be undertaken in all patients with unilateral inguinal involvement? At the authors' institute the timing of detection, the number of palpable nodes and the number of positive nodes found in the resection specimen were considered initially indicative for a contralateral lymphadenectomy.65 Patients who developed a unilateral inguinal recurrence during follow-up were managed by unilateral dissection assuming that bilateral nodal metastases develop at the same rate and that the absence of clinical nodal involvement of the contralateral side after observation suggested a tumor-free groin. Previous studies have suggested that the likelihood of bilateral involvement is related to the number of involved nodes in the unilateral resected inguinal specimen.1,65 With two or more metastases the probability of occult contralateral involvement is 30% and this may warrant an early contralateral inguinal lymphadenectomy. Currently, ultrasound-guided FNAC and DSNB are used to solve the problem at the authors' institute in those patients presenting initially with unilateral positive nodes. Contralateral groins with tumor-negative sentinel nodes are under close surveillance. Hence, nodal staging and management has emerged from treatment per patient to management per groin.

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