INGUINAL LYMPH NODE DISSECTION (ILND) IN LOWER LIMB CANCERS IN A SUB-SAHARAN ONCOLOGICAL SURGERY SETTING

TRAORE B*, BAH M, SOW MD, KOUROUMA T.

Surgical Oncology Unit of Donka, Teaching Hospital of Conakry, Faculty of Health Sciences and Technology, University Gamal Abdel Nasser of Conakry, Guinea

* ?Correspondence:Pr Agr Bangaly Traore Email: ucodonka@gmail.com
Source of funding: None
Conflict of interest: None

ABSTRACT

Background: The inguinal region is sometimes the site of lymph node metastases or primary sites of certain cancers. The lower limbs may be the site of cancers of cutaneous, bone or other soft tissue origin. The risk of inguinal lymph node involvement depends on the type of cancer, the depth of invasion and the stage of disease.

Aim: To describe the indications for and evaluate the results of inguinal lymph node dissection (ILND) in cases of lower limb cancers at the Surgical Oncology Unit of Donka, Conakry Hospital.

Materials and methods: Retrospective, descriptive, and analytical study of ILND in cases performed from 2007 to 2016. The anatomic and clinical characteristics, intraoperative findings, type of ILND performed, operative complications, histopathological findings and prognostic factors were evaluated.

Results: Twenty-five inguinal lymph node dissections were performed for 24 patients. Patients had a median age of 57 years (with a range of 11 to 78); the male to female sex ratio was 1.3. The operative indications were squamous cell carcinoma (10 cases), sarcoma (6 cases), melanoma (5 cases) and osteosarcoma (2 cases), and Kaposi’s sarcoma (1 case) (who underwent bilateral ILND with an interval of two years). The primary lesion was on the limb in 23 cases and in the Scarpa triangle in 2 cases. ILND was systematic in 23 cases and after inguinal relapse in 2 cases. It was superficial in 22 cases and deep in 3. Other surgical procedures included wide local excision of the primary tumor (10 cases), amputation (14 cases) and disarticulation (1 case). The margins of resection were free in 18 cases and invaded in 7 cases. The operative complications were delayed healing (5 cases), seroma (3 cases), and lymphedema (3 cases). After a median follow-up of 14 months, there were 8 cases of relapse and 11 deaths. Overall survival was 54.2%. Survival was 12 (70.6%) in those who had free margins and 1(14.3%) in the absence of free margins (p = 0.023); it was 12 (75.0%) in those without relapse and 1 (12.5%) in those with relapse (p=0.008).

Conclusion: Cutaneous malignancies are the commonest lower limb cancers. Systematic inguinal lymph node dissection is a common practice for management of lower limb cancer, in addition to various forms of excision of the primary tumour. Survival was higher in those who had free margins of the excised primary tumour and those who did not suffer a relapse. The less morbid sentinel lymph node technique should be placed in the context of early diagnosis of primary lesions.

Key words:Inguinal lymph node dissection; cancers; lower limb