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Malignancies
of the Groin
Keith A. Delman
Viraj A. Master
Editors
Surgical and Anatomic
Considerations
123
Malignancies of the Groin
Keith A. Delman • Viraj A. Master
Editors
Malignancies of the Groin
Surgical and Anatomic Considerations
ISBN 978-3-319-60857-0 ISBN 978-3-319-60858-7 (eBook)
https://doi.org/10.1007/978-3-319-60858-7
Library of Congress Control Number: 2017955813
© Springer International Publishing AG 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional afliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Editors
Keith A. Delman
Division of Surgical Oncology
Department of Surgery
Emory University School of Medicine
Atlanta, GA
USA
Viraj A. Master
Department of Urology
Emory University School of Medicine
Atlanta, GA
USA
v
Contents
1 History ofMinimally Invasive InguinalLymphadenectomy . . . . . . . 1
Marcos Tobias-Machado, Marcio Covas Moschovas, and Antonio
Augusto Ornellas
2 Epidemiology ofDiseases oftheGroin . . . . . . . . . . . . . . . . . . . . . . . . . 9
Michael Lowe
3 Anatomy oftheGroin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Andre Granger, Theofanis Kollias, and Marios Loukas
4 Complications ofInguinal Lymphadenectomy . . . . . . . . . . . . . . . . . . 39
Avinash Chenam and S. Mohammad A. Jafri
5 Surgical andNonsurgical Management ofLymphedema . . . . . . . . . . 55
Stephanie Kirkpatrick and Angela Cheng
6 Surgical andAnatomic Considerations ofMalignancies
Affecting theGroin: Consideration forMelanoma . . . . . . . . . . . . . . . 63
Alexander C.J. van Akkooi
7 Considerations forNonmelanoma Skin Cancer:
Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Matthew C. Perez, Carrie Luu, Amod A. Sarnaik,
and Jonathan S. Zager
8 Considerations forVulvar Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Vasileios D. Sioulas and Yukio Sonoda
9 Clinical Considerations andSurgical Management ofGroin
Disease inPenile andScrotal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Christine Ibilibor, Pranav Sharma, and Philippe E. Spiess
10 Soft Tissue Tumors of the Groin and Inguinal Region . . . . . . . . . . . . 123
Stefano Radaelli, Chiara Colombo, Marco Fiore,
and Alessandro Gronchi
vi
11 Malignant Inguinal Adenopathy: Considerations
fortheRadiation Oncologist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Martin Korzeniowski and Juanita Crook
12 Surgical Technique forOpen Inguinal Lymphadenectomy . . . . . . . . 185
Andrew J. Spillane and John F. Thompson
13 Surgical Technique forMinimally Invasive
Inguinal Lymphadenectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Clara Farley, Keith A. Delman, and Viraj A. Master
14 Other Approaches forReducing Surgical Risk . . . . . . . . . . . . . . . . . . 207
Antonio Sommariva
15 Surgical andAnatomic Considerations
ofMalignancies Affecting theGroin: Reconstructive
Approaches totheGroin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Seyed Amirhossein Razavi, Karan A. Desai, Albert Liao, and Albert
Losken
16 Quality ofLife andOutcomes inPatients
withMalignancies oftheGroin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Andrew J. Lambour and Sandra L. Wong
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Contents
vii
Contributors
Alexander C.J. van Akkooi, M.D., Ph.D. Department of Surgical Oncology,
Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The
Netherlands
AngelaCheng, M.D. Division of Plastic Surgery, Department of Surgery, Winship
Cancer Institute of Emory University, Atlanta, GA, USA
AvinashChenam, M.D. Division of Urology and Urologic Oncology, Department
of Surgery, City of Hope National Medical Center, Duarte, CA, USA
Chiara Colombo, M.D. Sarcoma Service, Department of Surgery, Fondazione
IRCCS Istituto Nazionale dei Tumori, Milan, Italy
JuanitaCrook, M.D., F.R.C.P.C. Division of Radiotherapy and Developmental
Radiotherapeutics, Department of Radiation Oncology, University of British
Columbia, BC Cancer Agency, Kelowna, British Columbia, Canada
KeithA.Delman, M.D., F.A.C.S.
Division of Surgical Oncology, Department of
Surgery, Emory University School of Medicine, Atlanta, GA, USA
KaranA.Desai, M.D. Division of Plastic Surgery, Department of Surgery, Emory
University Hospital Midtown, Emory University School of Medicine, Atlanta,
GA, USA
ClaraFarley, M.D. Department of Surgery, Emory University, Atlanta, GA, USA
MarcoFiore, M.D. Sarcoma Service, Department of Surgery, Fondazione IRCCS
Istituto Nazionale dei Tumori, Milan, Italy
Andre Granger, M.D. Department of Anatomical Sciences, St. George’s
University School of Medicine, Grenada, W.I.
Department of Neurology, NYU Langone Hospital - Brooklyn, Brooklyn, NY, USA
AlessandroGronchi, M.D. Sarcoma Service, Department of Surgery, Fondazione
IRCCS Istituto Nazionale dei Tumori, Milan, Italy
viii
ChristineIbilibor, M.D. Department of Urology, Texas Tech University Health
Sciences Center, Lubbock, TX, USA
S.MohammadA.Jafri, M.D. Department of Urology, Beaumont Health System,
Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
StephanieKirkpatrick, P.T., D.P.T., C.L.T. Department of Radiation Oncology,
Winship Cancer Institute of Emory University, Lymphedema Clinic, Atlanta, GA,
USA
Theofanis Kollias, M.D.
Department of Anatomical Sciences, St. George’s
University School of Medicine, Grenada, W.I.
Martin Korzeniowski, M.D., F.R.C.P.C. Division of Radiotherapy and
Developmental Radiotherapeutics, Department of Radiation Oncology, University
of British Columbia, BC Cancer Agency, Kelowna, British Columbia, Canada
Andrew J. Lambour, M.D. Department of Surgery, Dartmouth-Hitchcock
Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
Albert Liao, M.D. Division of Plastic Surgery, Department of Surgery, Emory
University Hospital Midtown, Emory University School of Medicine, Atlanta, GA,
USA
Albert Losken, M.D., F.A.C.S. Division of Plastic Surgery, Department of
Surgery, Emory University Hospital Midtown, Emory University School of
Medicine, Atlanta, GA, USA
MariosLoukas, M.D., Ph.D. Department of Anatomical Sciences, St. George’s
University School of Medicine, Grenada, W.I.
Michael Lowe, M.D. Division of Surgical Oncology, Department of Surgery,
Emory University School of Medicine, Atlanta, GA, USA
Carrie Luu, M.D. Department of Cutaneous Oncology, Moftt Cancer Center,
Tampa, Florida, USA
VirajA.Master, M.D., Ph.D., F.A.C.S. Department of Urology, Emory University
School of Medicine, Atlanta, GA, USA
MarcioCovasMoschovas, M.D. Section of Urologic Oncology, Department of
Urology, ABC Medical School, São Paulo, Brazil
AntonioAugustoOrnellas, M.D., Ph.D. Section of Urologic Oncology, National
Institute of Cancer, Rio de Janeiro, Brazil
Matthew C. Perez, M.D. Department of Surgery, Emory University School of
Medicine, Atlanta, GA, USA
Stefano Radaelli, M.D. Sarcoma Service, Department of Surgery, Fondazione
IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Contributors
ix
Seyed Amirhossein Razavi, M.D. Division of Plastic Surgery, Department of
Surgery, Emory University Hospital Midtown, Emory University School of
Medicine, Atlanta, GA, USA
AmodA. Sarnaik, M.D., F.A.C.S. Department of Cutaneous Oncology, Moftt
Cancer Center, Tampa, Florida, USA
Pranav Sharma, M.D. Department of Urology, Texas Tech University Health
Sciences Center, Lubbock, TX, USA
Vasileios D.Sioulas, M.D., Ph.D.
Gynecology Service, Department of Surgery,
Memorial Sloan Kettering Cancer Center, New York, NY, USA
AntonioSommariva, M.D. Surgical Oncology Unit, Veneto Institute of Oncology,
IOV-IRCCS, Padova, Italy
Yukio Sonoda, M.D. Gynecology Service, Department of Surgery, Memorial
Sloan Kettering Cancer Center, New York, NY, USA
PhilippeE.Spiess, M.D., M.S., F.R.C.S., F.A.C.S. Department of Genitourinary
Oncology, Moftt Cancer Center, Tampa, FL, USA
Andrew J. Spillane, M.D., F.R.A.C.S. Melanoma Institute Australia, The
University of Sydney, Sydney, NSW, Australia
John F. Thompson, M.D., F.R.A.C.S., F.A.C.S. Melanoma Institute Australia,
The University of Sydney, Sydney, NSW, Australia
MarcosTobias-Machado, M.D., Ph.D. Section of Urologic Oncology, Department
of Urology, ABC Medical School, São Paulo, Brazil
Sandra L. Wong, M.D., M.S. Department of Surgery, Dartmouth-Hitchcock
Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
JonathanS.Zager, M.D., F.A.C.S. Department of Cutaneous Oncology, Moftt
Cancer Center, Tampa, Florida, USA
Contributors
1© Springer International Publishing AG 2018
K.A. Delman, V.A. Master (eds.), Malignancies of the Groin,
https://doi.org/10.1007/978-3-319-60858-7_1
Chapter 1
History ofMinimally Invasive
InguinalLymphadenectomy
MarcosTobias-Machado, MarcioCovasMoschovas,
andAntonioAugustoOrnellas
Twentieth Century: Traditional Surgery Era
Cancer of the penis has been recognized for centuries, and its management was rst
described by Celsus [1] in the seventeenth century when he recommended an ampu-
tation for a penile carcinoma with cauterization of the raw stump to control bleed-
ing. However, only in the 1800s was inguinal lymphadenectomy recognized as a
routine to treat inguinal metastases [1, 2].
Almost 200years from the rst procedure to treat penile cancer, Young, in 1907,
recommended bilateral inguinal lymphadenectomy simultaneously with the penec-
tomy for penile carcinoma [3].
Daseler and associates, in 1948, after the dissection of 450 cadavers, found the
precise inguinal anatomic parameters, and Baronofsky, in the same year, advocated
one technique that is still widely employed, the transposition of sartorius muscle
over the femoral vessels [4].
The rst technique described for inguinal lymph node dissection (ILND) for
penile cancer found in Medline resources was attributed to Zenker and Pichlmaier
in 1966 [5]. Since then, hundreds of modications and new approaches have been
published.
Fegen and Persky rst associated the success of a complete inguinal dissection
with an increase in penile cancer survival rates [6].
M. Tobias-Machado (*) • M.C. Moschovas
Section of Urologic Oncology, Department of Urology,
ABC Medical School, São Paulo, Brazil
e-mail: tobias-machado@uol.com.br; marcio.doc@hotmail.com
A.A. Ornellas
Section of Urologic Oncology, National Institute of Cancer, Rio de Janeiro, Brazil
e-mail: ornellasa@hotmail.com