Curative Groin Dissection of Inguinal Lymph Node Metastasis from Lower Rectal Cancer: The Operative Technique and a Report of Four Cases

ABSTRACT

PURPOSE: Inguinal lymph node metastasis from rectal adenocarcinoma occurs infrequently and is generally considered as a manifestation of systemic metastasis. The prognosis is limited with all modalities of chemotherapy and radiotherapy. METHODS: Four of 610 patients with lower rectal cancer underwent curative groin dissection following identification of no other systemic metastasis. RESULTS: All patients had previously undergone abdomino-perineal resection and adjuvant chemo-radiotherapy as primary rectal cancer treatment. A synchronous inguinal lymph node metastasis was identified in one patient, whereas metachronous metastasis was found at seven, 12, and 14 months postoperatively in the remainly three patients. The survival time was from 2 to 22 months after curative groin dissection. One patient remains alive 22 months after the curative groin dissection showing neither perirectal lymph node nor systemic metastasis on primary surgery. CONCLUSION: Although radical groin dissection is rarely indicated in lower rectal cancer metastasis, it can be efficiently performed in cases without systemic metastasis. As the technique is also useful in other malignant metastasis, we introduce our operative procedure in addition to the report of the four cases.