Femoral vein ligation for groin recurrence in a woman with vulval squamous cell carcinoma: A case report

Abstract

The management of groin recurrences in women with vulval cancer presents a significant therapeutic challenge. Groin recurrences, particularly those involving the femoral vessels, are associated with poor outcomes. Historically, surgery was often not offered in such cases, exposing patients to the risk of fatal complications from femoral vessel blow-out, leading to exsanguination. This report describes the management of a right large vulval groin recurrence involving the femoral vein, treated successfully with femoral vein ligation. The patient's postoperative recovery was largely uneventful. This case highlights the feasibility of femoral vein ligation when performed with early involvement of vascular surgeons and a multidisciplinary team approach. Femoral vein ligation should be considered in cases of vessel invasion as it can be both life-saving and limb-sparing. Additionally, the report discusses the development of collateral venous circulation, which often compensates for femoral vein obstruction.

Keywords: Femoral vein ligation; Groin blow-out; Inguinofemoral metastasis; Multidisciplinary input; Vulval cancer.

Fig. 1

Five months after the right hemivulvectomy with pudendal thigh flap reconstruction.

Fig. 2

Right groin nodal metastasis six months after the vulvectomy.

Fig. 3

Cross-sectional imaging showing right femoral vein invasion and occlusion by the inguinal nodal metastasis.

Fig. 4

Intraoperative resection of right groin nodal tumour: (a) Invasion into inguinal ligament; (b) Tumour encasing femoral vein, sparing lateral femoral artery; (c) En bloc resection of pectineus muscle; (d) Post-resection view showing removal of tumour, femoral vein, pectineus, and sheath with proximal and distal vein ligation.

Fig. 5

Findings on postoperative day 10 with healing right inguinal and vulval incision (a) and grade 2 lymphoedema involving the right lower limb (b).