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Henderson MA, Gyorki D, Burmeister BH, Ainslie J, Fisher R, Di Iulio J, Smithers BM, Hong A, Shannon K, Scolyer RA, Carruthers S, Coventry BJ, Babington S, Duprat J, Hoekstra HJ, Thompson JF. Inguinal and Ilio-inguinal Lymphadenectomy in Management of Palpable Melanoma Lymph Node Metastasis: A Long-Term Prospective Evaluation of Morbidity and Quality of Life. Ann Surg Oncol 2019; 26:4663-4672. [DOI: 10.1245/s10434-019-07810-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Indexed: 12/22/2022]
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Dieng M, Kasparian NA, Cust AE, Costa DSJ, Tran A, Butow PN, Menzies SW, Mann GJ, Morton RL. Sensitivity of Preference-Based Quality-of-Life Measures for Economic Evaluations in Early-Stage Melanoma. JAMA Dermatol 2019; 154:52-59. [PMID: 29188268 DOI: 10.1001/jamadermatol.2017.4701] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The diagnosis of a life-threatening disease like melanoma can affect all aspects of a person's life, including health-related quality of life (HRQOL) and psychological aspects of melanoma such as fear of cancer recurrence (FCR). Economic evaluations of psychological interventions require preference-based (utility) instruments that are sensitive to changes in well-being and HRQOL; however, very few studies have evaluated the sensitivity of these instruments when used for people with melanoma. Objective To compare utility scores from the multiple-attribute instrument Assessment of Quality of Life-8-Dimension Scale (AQoL-8D) with the mapped utility scores of the Functional Assessment of Cancer Therapy-Melanoma (FACT-M) and to investigate the sensitivity of both instruments in identifying the influence of FCR on HRQOL. Design, Setting, and Participants This assessment of data from a randomized clinical trial of a psychoeducational intervention to reduce FCR, conducted at 3 high-risk melanoma clinics in Australia, evaluated 164 patients with early-stage melanoma and a high risk of developing a second primary melanoma. Main Outcomes and Measures The FACT-M and AQoL-8D were used to assess HRQOL and FCR among the study participants. Concurrent validity was assessed by comparing the total and subdomain scores of the 2 instruments, and the strength of associations was assessed using Pearson correlation coefficient. Convergent validity was assessed by comparing participants' HRQOL, demographic, and clinical characteristics using the χ2 test and F statistic. Both the FACT-M and AQoL-8D utilities were regressed on FCR Inventory (FCRI) severity scores to estimate the effect of elevated FCR on HRQOL. Results A total of 164 participants completed the baseline questionnaires, but only 163 met all inclusion criteria and underwent the full analysis: 72 were women; 91 were men; and mean (SD) age was 58.2 (12.1) years. Both the AQoL-8D and FACT-M instruments showed good concurrent validity and could differentiate between relevant subgroups including level of FCRI severity. The AQoL-8D and FACT-M utilities were strongly correlated (r2 = 0.57). Respondents had a mean (SD) AQoL-8D utility of 0.77 (0.2), and a mean (SD) FACT-M utility score of 0.76 (0.07). High levels of FCRI severity were associated with a decrease in utility of 0.12 (95% CI, -0.19 to -0.05) as measured by AQoL-8D, and a decrease of 0.03 (95% CI, -0.05 to -0.01) as measured by the FACT-M. Conclusions and Relevance For economic evaluations of psychological interventions in melanoma, the AQoL-8D and FACT-M are valid measures of utility; however, the AQoL-8D demonstrates greater sensitivity to FCRI severity. Our results suggest a significant association between FCR and HRQOL.
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Affiliation(s)
- Mbathio Dieng
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia
| | - Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia.,Melanoma Institute Australia, University of Sydney, North Sydney, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St Leonards, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Anh Tran
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia
| | - Phyllis N Butow
- Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, Australia
| | - Scott W Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, Australia.,The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Graham J Mann
- Melanoma Institute Australia, University of Sydney, North Sydney, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - Rachael L Morton
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia
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Evaluation of the videoscopic inguinal lymphadenectomy in melanoma patients. Eur J Surg Oncol 2019; 45:1712-1716. [PMID: 31056364 DOI: 10.1016/j.ejso.2019.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/12/2019] [Accepted: 04/24/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION A completion or therapeutic inguinal lymph node dissection is a procedure accompanied with a high rate of postoperative complications. A novel, minimally invasive alternative has been developed; the videoscopic inguinal lymphadenectomy. The aim of this study is to present our first experience with the videoscopic inguinal lymphadenectomy among melanoma patients with inguinal metastases. METHODS Melanoma patients with a histologically confirmed inguinal metastases who underwent a videoscopic inguinal lymphadenectomy between November 2015 and January 2018 were included. Outcome measures were operation time, nodal yield, and postoperative complications. Furthermore, lymphedema measurements were performed both subjectively and objectively. RESULTS A total of 20 patients (3 males and 17 females) underwent a videoscopic inguinal lymphadenectomy. In 75% of patients the procedure was combined with an open iliac lymphadenectomy. Median operation time of the videoscopic procedure was 110 min (range, 79-165). There were no perioperative complications or conversions. In 12 patients (60%) there was ≥1 postoperative complication. The most frequent complications were seroma and wound infection. All complications were treated conservatively without the need for a surgical re-intervention. The median nodal yield of the videoscopic procedure was 9 (range, 1-19). Lymphedema was present in nine patients (45%) after three months of follow-up. CONCLUSION Our initial results show that the videoscopic inguinal lymphadenectomy is an attractive alternative to the conventional open technique. The number of complications is comparable with the complication rate reported for the conventional open procedure, but they are less severe and there is no need for a surgical re-intervention.
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Gerken ALH, Dobroschke J, Reißfelder C, Hetjens S, Braun V, Di Monta G, Jakob J, Hohenberger P, Nowak K, Herrle F. Tissue sealants for the prevention of lymphoceles after radical inguinal lymph node dissection in patients with melanoma: A systematic review and individual patient data meta-analysis. J Surg Oncol 2019; 119:728-736. [PMID: 30674074 DOI: 10.1002/jso.25366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/11/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Postoperative lymphoceles and further wound complications occur frequently after radical inguinal lymph node dissection (ILND). In various studies, tissue sealants have shown to reduce the incidence of postoperative morbidity. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the effectiveness of tissue sealants in reducing the incidence of postoperative lymphoceles following ILND in patients with melanoma was conducted. Individual patient data was requested to pool the data for meta-analysis appropriately. RESULTS Thousand seven hundred twenty-nine manuscripts were screened for eligibility. Six RCTs published between 1986 and 2012 were identified including 194 patients for ILND. Only four RCTs were included in the meta-analysis. No study properly defined the term "lymphocele." Tissue sealants failed to influence the duration of drain placement (mean difference [MD] = -3.05 days; z = 1.18; P = 0.24), total drainage volume (MD = 598.39 mL; z = 1.49; P = 0.14), the incidence of postoperative seroma, wound infection and skin necrosis. CONCLUSIONS No improvement was identified with the use of tissue sealants, however, a valid comparison of the results of included trials was difficult owing to the lack of a definition of the term "lymphocele." Other surgical techniques and trials using validated endpoint definitions are required to reevaluate these findings.
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Affiliation(s)
- Andreas L H Gerken
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jakob Dobroschke
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Christoph Reißfelder
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Svetlana Hetjens
- Department of Biometry and Statistics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Volker Braun
- Library, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Gianlica Di Monta
- Department of Surgery, Melanoma, Soft Tissues, Head and Neck, Skin Cancers, National Cancer Institute of Naples, Naples, Italy
| | - Jens Jakob
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - Kai Nowak
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,Department of General, Vascular and Thoracic Surgery, RoMed Hospital Rosenheim, Rosenheim, Germany
| | - Florian Herrle
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Jørgensen MG, Toyserkani NM, Hyldig N, Chakera AH, Hölmich LR, Thomsen JB, Sørensen JA. Prevention of seroma following inguinal lymph node dissection with prophylactic, incisional, negative-pressure wound therapy (SEROMA trial): study protocol for a randomized controlled trial. Trials 2018; 19:441. [PMID: 30111378 PMCID: PMC6094459 DOI: 10.1186/s13063-018-2757-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/23/2018] [Indexed: 12/12/2022] Open
Abstract
Background Radical inguinal lymphadenectomy (ILND) for metastatic melanoma is associated with a high complication rate. Seroma is often the first postoperative complication, followed by prolonged wound healing sometimes requiring reoperation, infection, multiple outpatient visits and re-hospitalization. Prevention of seroma may, therefore, lead to a reduction in many of the other complications. Methods/design The primary aim of this randomized study is to investigate whether fewer patients require treatment for seroma by immediate prophylactic application of incisional, Negative-pressure Wound Therapy (iNPWT) following ILND, compared to standard postoperative treatment. The secondary outcomes include surgical-site infection, dehiscence, hematoma, length of hospitalization, quality of life, safety, long-term assessment of lymphedema and non-inferiority oncological outcome. Data will be registered prospectively at check-ups after 7 and 14 days, 1 and 3 months and 2 years after inguinal lymphadenectomy using case report forms and questionnaires and stored in a secure online database. Discussion To our knowledge, this trial is the first randomized study evaluating negative-pressure wound therapy as a prophylactic intervention for complications following melanoma-related ILND. The results from this trial will hopefully determine the efficacy and safety of prophylactic iNPWT treatment in prevention of the clinical relevant short- and long-term postoperative complications following ILND and may provide an evidence base for the an improved postoperative regimen. Trial registration ClinicalTrials.gov, ID: NCT03433937. Prospectively registered on 15 February 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-2757-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mads Gustaf Jørgensen
- Department of Plastic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Navid Mohamadpour Toyserkani
- Department of Plastic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Department of Plastic Surgery, Roskilde Hospital, Roskilde, Denmark
| | - Nana Hyldig
- Hans Christian Andersen's Children Hospital, Odense University Hospital, Odense, Denmark
| | | | | | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
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Abstract
In the contemporary era of medical diagnosis via sophisticated radiographic imaging and/or comprehensive serological testing, a focused physical examination remains paramount in recognizing the cutaneous manifestations of chronic vascular disease. Recognition of the unique cutaneous signs of lymphatic and venous hypertension assists in the diagnosis as well as the staging and classification of both lymphedema and chronic venous insufficiency. Awareness of explicit dermatologic vasomotor manifestations aids not only in the identification of acrocyanosis, Raynaud phenomenon, pernio, and erythromelalgia but also mitigates confusion related to their clinical overlap. Although the clinical signs of peripheral artery disease are not necessarily specific or sensitive, a knowledge of suggestive dermatologic findings is helpful in recognition of severe limb ischemia. A brief review of the epidemiology, etiology, pathogenesis, and therapy of cutaneous related chronic vascular disease follows including an emphasis on characteristic clinical features supported by illustrative photographs.
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Affiliation(s)
- Steven M Dean
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH.
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Bjurlin MA, Makarov DV. Management of Penile Cancer. Rev Urol 2018; 20:46-48. [PMID: 29942204 PMCID: PMC6003306 DOI: 10.3909/riu2001nyucom] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Marc A Bjurlin
- Department of Urology, NYU Langone Hospital-Brooklyn Brooklyn, NY
| | - Danil V Makarov
- Department of Urology, NYU Langone Hospital-Brooklyn Brooklyn, NY
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58
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Postlewait LM, Farley CR, Seamens AM, Le N, Rizzo M, Russell MC, Lowe MC, Delman KA. Morbidity and Outcomes Following Axillary Lymphadenectomy for Melanoma: Weighing the Risk of Surgery in the Era of MSLT-II. Ann Surg Oncol 2017; 25:465-470. [DOI: 10.1245/s10434-017-6242-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Indexed: 11/18/2022]
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Ascha M, Ascha MS, Gastman B. Identification of Risk Factors in Lymphatic Surgeries for Melanoma: A National Surgical Quality Improvement Program Review. Ann Plast Surg 2017; 79:509-515. [PMID: 28650410 DOI: 10.1097/sap.0000000000001152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) and lymphadenectomy (LAD) are commonly performed in the staging and care of patients with malignant melanoma. These procedures are accompanied by complications that may result in hospital readmission, negatively affecting patient outcomes and potentially affecting surgical procedure reimbursement. The National Surgical Quality Improvement Program (NSQIP) database offers a large data set allowing physicians to evaluate 30-day readmission for surgical complications. We used this database to explore predictors of 30-day hospital readmission for SLNB and LAD in the axillary, cervical, and inguinal regions. METHODS Data from the years 2005 to 2014 of the American College of Surgeons NSQIP database were used. Cohorts were constructed according to International Classification of Diseases, Ninth Revision, classification and current procedural terminology codes. The outcome of 30-day return to hospital was defined as patients who were readmitted to the hospital or the operating room within 30 days. Multiple logistic regression results are presented for a prespecified set of predictors and predictors that were significant on univariate logistic regression analysis. Odds ratios and confidence intervals were calculated using maximum likelihood estimates, along with Wald test P values. RESULTS A total of 3006 patients were included. Of those, 151 (5.0%) returned to the hospital. Among 1235 LAD patients, 65 (5.3%) returned; among 1771 SLNB patients, 86 (4.9%) returned. Smoking was a predictor of hospital readmission for overall SLNB and for cervical SLNB on multivariate analysis. Age was a significant predictor for cervical and inguinal LAD. Hypertension was significant for cervical LAD. Diabetes, preoperative hematocrit, and male sex were predictors for inguinal SLNB. There were no significant predictors for axillary SLNB and axillary LAD, as well as overall LAD procedures. CONCLUSIONS This is the first and largest study using American College of Surgeons NSQIP to examine 30-day readmission after SLNB and LAD for melanoma in 3 commonly operated anatomical regions. We have found several significant risk factors associated with hospital readmission, which are now being used as a quality measure for hospital performance and reimbursement, that may help surgeons optimize patient selection for SLNB and LAD.
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Affiliation(s)
- Mona Ascha
- From the *Case Western Reserve University School of Medicine; †Center for Clinical Investigation, Department of Epidemiology and Biostatistics, Case Western Reserve University; and ‡Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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A prediction tool incorporating the biomarker S-100B for patient selection for completion lymph node dissection in stage III melanoma. Eur J Surg Oncol 2017; 43:1753-1759. [DOI: 10.1016/j.ejso.2017.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/23/2017] [Accepted: 07/13/2017] [Indexed: 11/20/2022] Open
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62
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Postlewait LM, Farley CR, Diller ML, Martin B, Hart Squires M, Russell MC, Rizzo M, Ogan K, Master V, Delman K. A Minimally Invasive Approach for Inguinal Lymphadenectomy in Melanoma and Genitourinary Malignancy: Long-Term Outcomes in an Attempted Randomized Control Trial. Ann Surg Oncol 2017; 24:3237-3244. [DOI: 10.1245/s10434-017-5971-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 12/15/2022]
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63
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Sulfuretin has therapeutic activity against acquired lymphedema by reducing adipogenesis. Pharmacol Res 2017; 121:230-239. [DOI: 10.1016/j.phrs.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 01/30/2023]
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Developing a standardized healthcare cost data warehouse. BMC Health Serv Res 2017; 17:396. [PMID: 28606088 PMCID: PMC5469019 DOI: 10.1186/s12913-017-2327-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 05/22/2017] [Indexed: 01/17/2023] Open
Abstract
Background Research addressing value in healthcare requires a measure of cost. While there are many sources and types of cost data, each has strengths and weaknesses. Many researchers appear to create study-specific cost datasets, but the explanations of their costing methodologies are not always clear, causing their results to be difficult to interpret. Our solution, described in this paper, was to use widely accepted costing methodologies to create a service-level, standardized healthcare cost data warehouse from an institutional perspective that includes all professional and hospital-billed services for our patients. Methods The warehouse is based on a National Institutes of Research–funded research infrastructure containing the linked health records and medical care administrative data of two healthcare providers and their affiliated hospitals. Since all patients are identified in the data warehouse, their costs can be linked to other systems and databases, such as electronic health records, tumor registries, and disease or treatment registries. Results We describe the two institutions’ administrative source data; the reference files, which include Medicare fee schedules and cost reports; the process of creating standardized costs; and the warehouse structure. The costing algorithm can create inflation-adjusted standardized costs at the service line level for defined study cohorts on request. Conclusion The resulting standardized costs contained in the data warehouse can be used to create detailed, bottom-up analyses of professional and facility costs of procedures, medical conditions, and patient care cycles without revealing business-sensitive information. After its creation, a standardized cost data warehouse is relatively easy to maintain and can be expanded to include data from other providers. Individual investigators who may not have sufficient knowledge about administrative data do not have to try to create their own standardized costs on a project-by-project basis because our data warehouse generates standardized costs for defined cohorts upon request. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2327-8) contains supplementary material, which is available to authorized users.
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Safety and Feasibility of Minimally Invasive Inguinal Lymph Node Dissection in Patients With Melanoma (SAFE-MILND): Report of a Prospective Multi-institutional Trial. Ann Surg 2017; 265:192-196. [PMID: 28009745 DOI: 10.1097/sla.0000000000001670] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Minimally invasive inguinal lymph node dissection (MILND) is a novel approach to inguinal lymphadenectomy. SAFE-MILND (NCT01500304) is a multicenter, phase I/II clinical trial evaluating the safety and feasibility of MILND for patients with melanoma in a group of surgeons newly adopting the procedure. METHODS Twelve melanoma surgeons from 10 institutions without any previous MILND experience, enrolled patients into a prospective study after completing specialized training including didactic lectures, participating in a hands-on cadaveric laboratory, and being provided an instructional DVD of the procedure. Complications and adverse postoperative events were graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events Version 4.0. RESULTS Eighty-seven patients underwent a MILND. Seventy-seven cases (88.5%) were completed via a minimally invasive approach. The median total inguinal lymph nodes pathologically examined (SLN + MILND) was 12.0 (interquartile range 8.0, 14.0). Overall, 71% of patients suffered an adverse event (AE); the majority of these were grades 1 and 2, with 26% of patients experiencing a grade 3 AE. No grade 4 or 5 AEs were observed. CONCLUSIONS After a structured training program, high-volume melanoma surgeons adopted a novel surgical technique with a lymph node retrieval rate that met or exceeded current oncologic guidelines and published benchmarks, and a favorable morbidity profile.
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Baur J, Mathe K, Gesierich A, Weyandt G, Wiegering A, Germer CT, Gasser M, Pelz JOW. Morbidity and oncologic outcome after saphenous vein-sparing inguinal lymphadenectomy in melanoma patients. World J Surg Oncol 2017; 15:99. [PMID: 28490340 PMCID: PMC5425969 DOI: 10.1186/s12957-017-1164-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inguinal lymph node dissection (LND) is a surgical procedure with a high morbidity rate. Variations in surgical procedure, such as sparing of the saphenous vein, have been proposed to reduce surgical morbidity. While sparing of the saphenous vein has shown promising results in earlier studies, data for this procedure in melanoma patients are rare. In this retrospective study, we report 10-year findings on the effects of saphenous vein-sparing LND on surgical morbidity and oncologic outcomes in melanoma patients. METHODS A retrospective analysis of melanoma patients receiving inguinal LND in our facility between 2003 and 2013 was performed. Patients were divided into two groups: the saphenous vein resection group and the vein sparing group. Surgical morbidity, including wound infection, lymphatic fistula, severe bleeding, neurological complications, and chronic lymphedema, as well as regional recurrence-free survival were investigated. RESULTS A total of 106 patients were included in this study; of these, the saphenous vein was spared in 41 patients (38.7%). The rate of lymphatic fistula was 51.6 vs. 48.8%, wound infection occurred in 31.3 vs. 24.4%, and patients suffered from chronic lymphedema in 30.0 vs. 26.5% in V. saphena magna resection vs. sparing group. Differences observed, however, were not significant. No difference in regional recurrence-free survival between the two study groups was detected. CONCLUSIONS The results of our retrospective analysis could not confirm the promising results reported in earlier studies. Thus, sparing of the saphenous vein appears to be optional.
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Affiliation(s)
- Johannes Baur
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany.
| | - Katrin Mathe
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Anja Gesierich
- Department of Dermatology, Venerology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Gerhard Weyandt
- Department of Dermatology, Venerology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Martin Gasser
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Jörg O W Pelz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
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Vulvar postoperative care, gestalt or evidence based medicine? A comprehensive systematic review. Gynecol Oncol 2017; 145:386-392. [DOI: 10.1016/j.ygyno.2017.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022]
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68
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Schuitevoerder D, Leong SPL, Zager JS, White RL, Avisar E, Kosiorek H, Dueck A, Fortino J, Kashani-Sabet M, Hart K, Vetto JT. Is pelvic sentinel node biopsy necessary for lower extremity and trunk melanomas? Am J Surg 2017; 213:921-925. [PMID: 28411863 DOI: 10.1016/j.amjsurg.2017.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 01/17/2017] [Accepted: 03/21/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is currently no consensus regarding how to address pelvic sentinel lymph nodes (PSLNs) in melanoma. Thus, our objectives were to identify the incidence and clinical impact of PSLNs. METHODS Retrospective review of a prospectively collected multi-institutional melanoma database. RESULTS Of 2476 cases of lower extremity and trunk melanomas, 227 (9%) drained to PSLNs (181 to both PSLNs and superficial (inguinal or femoral) sentinel lymph nodes (SSLN) and 46 to PSLNs alone). Seventeen (7.5%) of 227 PSLN cases were positive for nodal metastasis, 8 of which drained to PSLNs only while 9 drained to both PSLNs and SSLNs. Complication rates between PSLN and SSLN biopsy were similar (15% vs. 14% respectively). In 181 cases with drainage to both SSLNs and PSLNs, PSLN biopsy upstaged one patient (0.6%), and completion dissection based on a positive PSLN did not upstage any. CONCLUSIONS PSLN biopsy is safe, however in the setting of negative SSLNs there is minimal clinical impact. We therefore recommend PSLN biopsy when the SSLNs are positive or when the tumor drains to PSLNs alone.
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Affiliation(s)
| | - Stanley P L Leong
- Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA
| | - Jonathan S Zager
- Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard L White
- Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Eli Avisar
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Heidi Kosiorek
- Section of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Amylou Dueck
- Section of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jeanine Fortino
- Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Mohammed Kashani-Sabet
- Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA
| | - Kyle Hart
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - John T Vetto
- Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Portland, OR, USA
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69
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Yamamoto T, Yamamoto N, Yoshimatsu H, Narushima M, Koshima I. Factors Associated with Lower Extremity Dysmorphia Caused by Lower Extremity Lymphoedema. Eur J Vasc Endovasc Surg 2017; 54:69-77. [PMID: 28392114 DOI: 10.1016/j.ejvs.2017.02.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Indocyanine green (ICG) lymphography has been reported to be useful for the early diagnosis of lymphoedema. However, no study has reported the usefulness of ICG lymphography for evaluation of lymphoedema with lower extremity dysmorphia (LED). This study aimed to elucidate independent factors associated with LED in secondary lower extremity lymphoedema (LEL) patients. METHODS This was a retrospective observational study of 268 legs of 134 secondary LEL patients. The medical charts were reviewed to obtain data of clinical demographics and ICG lymphography based severity stage (leg dermal backflow [LDB] stage). LED was defined as a leg with a LEL index of 250 or higher. Logistic regression analysis was used to identify independent factors associated with LED. RESULTS LED was observed in 106 legs (39.6%). Multivariate analysis revealed that independent factors associated with LED were higher LDB stages compared with LDB stage 0 (LDB stage III; OR 17.586; 95% CI 2.055-150.482; p = .009) (LDB stage IV; OR 76.794; 95% CI 8.132-725.199; p < .001) (LDB stage V; OR 47.423; 95% CI 3.704-607.192; p = .003). On the other hand, inverse associations were observed in higher age (65 years or older; OR 0.409; 95% CI 0.190-0.881; p = .022) and higher body mass index (25 kg/m2 or higher; OR 0.408; 95% CI 0.176-0.946; p = .037). CONCLUSIONS Independent factors associated with LED were elucidated. ICG lymphography based severity stage showed the strongest association with LED, and was useful for evaluation of progressed LEL with LED.
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Affiliation(s)
- T Yamamoto
- Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
| | - N Yamamoto
- Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - H Yoshimatsu
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - M Narushima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
| | - I Koshima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan
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70
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Theodore JE, Frankel AJ, Thomas JM, Barbour AP, Bayley GJ, Allan CP, Wagels M, Smithers BM. Assessment of morbidity following regional nodal dissection in the axilla and groin for metastatic melanoma. ANZ J Surg 2017; 87:44-48. [PMID: 27102082 DOI: 10.1111/ans.13526] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study assessed and compared the morbidity of nodal dissection in the axilla and groin including sentinel lymph node biopsy (SLNB), completion lymph node dissection for a positive SLNB (CLND) and therapeutic lymph node dissection (TLND) with and without adjuvant radiotherapy (RT). METHODS Patients who had nodal dissection in the axilla or groin for cutaneous melanoma over an 18-year period (1995-2013) were prospectively documented on a database. The median follow-up was nearly 3 years. Early complications and clinically relevant lymphoedema were retrospectively analysed to assess the incidence and differences between the region and type of nodal surgery. RESULTS Included were 1521 patients following nodal dissection in the axilla (916 patients) and groin (605 patients). Less early complications occurred following SLNB in the axilla compared with the groin (5% versus 14%, P = 0.0001). Early complications were similar for CLND and TLND in the groin (49% versus 43%, P = 0.879) and axilla (28% versus 33%, P = 0.607). Moderate to severe lymphoedema rates were similar following axillary SLNB and CLND (6% versus 8%, P = 0.407). The lymphoedema rate for groin SLNB was lower than CLND (10% versus 20%, P = 0.063). No significant difference in lymphoedema rates followed CLND and TLND in each region. Following TLND, RT increased lymphoedema rates. CONCLUSIONS Morbidity may occur following SLNB with the groin having a higher rate of early complications and lymphoedema compared with the axilla. The morbidity following CLND and TLND were similar. Lymphoedema rates were increased following RT.
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Affiliation(s)
- Jane E Theodore
- The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Mater Health Services, Brisbane, Queensland, Australia
| | - Adam J Frankel
- The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Janine M Thomas
- The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Mater Research Institute, Mater Health Services, Brisbane, Queensland, Australia
| | - Andrew P Barbour
- The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Gerard J Bayley
- The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Christopher P Allan
- The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Mater Health Services, Brisbane, Queensland, Australia
| | - Michael Wagels
- The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - B Mark Smithers
- The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
- Mater Research Institute, Mater Health Services, Brisbane, Queensland, Australia
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71
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Delman KA, Lowe MC. Revisiting the Strait of Messina: The Balance Between Optimal Oncologic Outcomes and Complications From Surgery. Ann Surg Oncol 2016; 24:302-304. [PMID: 27619941 DOI: 10.1245/s10434-016-5533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Keith A Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
| | - Michael C Lowe
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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72
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Greuter L, Klein HJ, Rezaeian F, Giovanoli P, Lindenblatt N. Evaluation of factors in seroma formation and complications in sentinel and radical lymph node dissections in skin cancer patients. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1242-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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73
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Faut M, Heidema RM, Hoekstra HJ, van Ginkel RJ, Been SLB, Kruijff S, van Leeuwen BL. Morbidity After Inguinal Lymph Node Dissections: It Is Time for a Change. Ann Surg Oncol 2016; 24:330-339. [PMID: 27519351 PMCID: PMC5215190 DOI: 10.1245/s10434-016-5461-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inguinal lymph node dissection (ILND) for stage 3 melanoma is accompanied by high wound complication rates. During the past decades, several changes in perioperative care have been instituted to decrease the incidence of these complications. This study aimed to evaluate the effect of these different care protocols on wound complications after ILND. METHODS A retrospective analysis of prospectively collected data was performed with 240 patients who underwent an ILND in the University Medical Center Groningen between 1989 and 2014. Four groups with different treatment protocols were analyzed: A (≥10 days of bed rest with a Bohler Braun splint), B (10 days of bed rest without a splint), C (5 days of bed rest), and D (1 day of bed rest). The effect of early mobilization, abolishment of the Bohler Braun splint and postural restrictions, and the introduction of prophylactic antibiotics were analyzed. RESULTS One or more wound complications occurred in 51.2 % of the patients including wound infection (29.8 %), seroma (21.5 %), wound necrosis (13.6 %), and hematoma (5 %). In consecutive periods, respectively 44.4, 60.3, 44.9 and 55.2 % of the patients experienced wound complications. None of the instituted changes in protocols led to a decrease in wound complications. CONCLUSION Changes in perioperative care protocols did not affect the rate of wound complications. Perhaps a change in the surgical procedure itself can lead to the necessary reduction of wound complications after ILND.
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Affiliation(s)
- Marloes Faut
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rianne M Heidema
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Robert J van Ginkel
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - S Lukas B Been
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
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74
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Liu JB, Bilimoria KY. Weighing the value of completion nodal dissection for melanoma. J Surg Oncol 2016; 114:281-7. [PMID: 27444517 DOI: 10.1002/jso.24273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/13/2016] [Indexed: 02/05/2023]
Abstract
In the United States, approximately half of patients with a positive sentinel lymph node biopsy undergo a completion lymphadenectomy. Because of the equivocal survival benefits in pursuing a completion lymphadenectomy in these patients, surgeons must weigh the postoperative morbidity of the operation with concerns facing a patient's quality of life and risk of tumor recurrence. We discuss the value of a completion lymphadenectomy in light of the uncertainties facing this management strategy for melanoma. J. Surg. Oncol. 2016;114:281-287. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jason B Liu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of Chicago Hospitals, Chicago, Illinois
| | - Karl Y Bilimoria
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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75
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Sánchez A, Sotelo R, Rodriguez O, Sánchez R, Rosciano J, Medina L, Vegas L. Robot-assisted video endoscopic inguinal lymphadenectomy for melanoma. J Robot Surg 2016; 10:369-372. [PMID: 27173971 DOI: 10.1007/s11701-016-0599-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/26/2016] [Indexed: 11/24/2022]
Abstract
Inguinal lymphadenectomy is the indicated procedure in the regional lymph node management for patients with lower limb melanoma and positive nodes. This procedure is commonly associated with surgical site complications. Video endoscopic inguinal lymphadenectomy is a minimally invasive alternative with oncological principles and lower wound-related morbidity. Incorporation of robotic surgery with optimal vision and great maneuverability would offer great advantages. A 42-year-old male patient was diagnosed with acral lentiginous melanoma and palpable inguinal nodes T2 N1 M0. The patient was scheduled for robot-assisted left inguinal video endoscopic lymphadenectomy. The working space is created using blunt-finger dissection and then extended with the endoscope by sweeping with the lens. Two 8-mm robotic trocars and a 10-mm trocar for assistant are placed. The lymphadenectomy is carried out with Maryland and scissors. The operative time was 130 min, estimated blood loss 70 ml and hospital stay 2 days. The robot-assisted inguinal video endoscopic lymphadenectomy is a safe and feasible procedure for lower limb melanoma treatment. The incorporation of the robotic system to this approach where there is a limited working space would offer advantages to the technique.
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Affiliation(s)
- Alexis Sánchez
- Robotic Surgery Program, Medicine Faculty, University Hospital of Caracas, Central University of Venezuela, Caracas, Venezuela
- Robotic and Minimally Invasive Surgery (UNIC), Caracas, Venezuela
| | - Rene Sotelo
- University of Southern California, Los Angeles, USA
| | - Omaira Rodriguez
- Robotic Surgery Program, Medicine Faculty, University Hospital of Caracas, Central University of Venezuela, Caracas, Venezuela.
- Robotic and Minimally Invasive Surgery (UNIC), Caracas, Venezuela.
| | - Renata Sánchez
- Robotic Surgery Program, Medicine Faculty, University Hospital of Caracas, Central University of Venezuela, Caracas, Venezuela
- Robotic and Minimally Invasive Surgery (UNIC), Caracas, Venezuela
| | - José Rosciano
- Robotic Surgery Program, Medicine Faculty, University Hospital of Caracas, Central University of Venezuela, Caracas, Venezuela
| | - Luis Medina
- Robotic Surgery Program, Medicine Faculty, University Hospital of Caracas, Central University of Venezuela, Caracas, Venezuela
| | - Liumariel Vegas
- Robotic Surgery Program, Medicine Faculty, University Hospital of Caracas, Central University of Venezuela, Caracas, Venezuela
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76
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Sommariva A, Pasquali S, Cona C, Ciccarese AA, Saadeh L, Campana LG, Meroni M, Rossi CR. Videoscopic ilioinguinal lymphadenectomy for groin lymph node metastases from melanoma. Br J Surg 2016; 103:1026-32. [PMID: 27146356 DOI: 10.1002/bjs.10140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/02/2015] [Accepted: 02/03/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Groin lymph node dissection for melanoma is burdened by high postoperative morbidity. Videoscopic lymphadenectomy may lower the incidence of complications, including infection, dehiscence and lymphoedema. This pilot study aimed to investigate the feasibility and postoperative outcomes of videoscopic ilioinguinal lymphadenectomy in patients with inguinal nodal melanoma metastases. METHODS Patients with inguinal nodal metastases, with either a positive sentinel lymph node biopsy or clinically positive nodes from melanoma, were enrolled. Inguinal dissection was performed via three ports. Iliac dissection was obtained through a preperitoneal access. Intraoperative and postoperative data were collected. RESULTS Of 23 patients selected for 24 procedures, four needed conversion to an open procedure. Median duration of surgery was 270 (i.q.r. 245-300) min. Wound-related postoperative complications occurred in four patients, although only one needed further intervention. The median number of excised lymph nodes was 21 (i.q.r. 15-25). After a median follow-up of 18 months, regional lymph node recurrence was observed in two patients. CONCLUSION Videoscopic ilioinguinal lymphadenectomy for melanoma groin lymph node metastases is technically feasible, safe, and associated with acceptable morbidity and oncological outcome.
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Affiliation(s)
- A Sommariva
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - S Pasquali
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - C Cona
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - A A Ciccarese
- Anaesthesiology Units, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - L Saadeh
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - L G Campana
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - M Meroni
- Anaesthesiology Units, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - C R Rossi
- Surgical Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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77
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Stollwerck PL, Schlarb D, Münstermann N, Stenske S, Kruess C, Brodner G, Krapohl BD, Krause-Bergmann AF. Reducing morbidity with surgical adhesives following inguinal lymph node dissections for the treatment of malignant skin tumors. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 5:Doc05. [PMID: 26816671 PMCID: PMC4724756 DOI: 10.3205/iprs000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Inguinal lymph node dissection (ILND) is associated with a high rate of morbidity. To evaluate the clinical benefit of surgical adhesives to reduce complications in patients undergoing ILND, we compared the use of TissuGlu® Surgical Adhesive and ARTISS® fibrin sealant with a control population. Material and methods: We conducted a retrospective analysis of patients undergoing ILND for metastatic malignant skin tumors at one hospital, Fachklinik Hornheide (Münster, Germany), from January 2011 through September 2013, assessing 137 patients with a total of 142 procedures. Results: Complications occurred in 22/60 procedures in the TissuGlu group (TG), in 8/17 in the ARTISS group (AG), and in 29/65 in the control group (CG). Prolonged drainage and seroma were recorded in 16 (26.7%), four (23.5%), and 26 (40%) respectively (non-significant). TG showed less extended drainage vs. CG (p=0.082). Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). With regard to wound infection, there was a 15% reduction in TG and 74% increase in AG group. Revision surgery was reduced by 36% in TG and increased by 54% in AG. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). Mean total post-operative drain volume was lower in TG and AG vs. CG (p<0.001 among groups, CG vs. TG p<0.001, CG vs. AG p<0.001). The mean body mass index (BMI) was significantly higher in patients with complications, 29.4±5.8 vs. 25.3±4.1 (p=0.000). Conclusion: The use of TissuGlu in our ILND patients was associated with a reduction in post-operative wound related complications and the need for revision surgeries compared to the control group. Daily drainage was significantly lower within the first 7 post-operative days with the use of ARTISS, but the benefit was lost due to the higher occurrence of wound infection and revision surgery. BMI above 29 is a risk factor for complications following ILND. (Level of evidence: level IV, retrospective case study)
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Affiliation(s)
- Peter L Stollwerck
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Dominik Schlarb
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Nicole Münstermann
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Sebastian Stenske
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Christoph Kruess
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany
| | - Gerhard Brodner
- Department of Anesthesiology, Intensive Care and Pain Medicine, Fachklinik Hornheide, Münster, Germany
| | - Björn Dirk Krapohl
- Department for Plastic Surgery and Hand Surgery, St. Marien Hospital, Berlin, Germany; Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Germany
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78
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Risk factors associated with lymphedema after lymph node dissection in melanoma patients. Am J Surg 2015; 210:1178-84; discussion 1184. [DOI: 10.1016/j.amjsurg.2015.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/12/2015] [Accepted: 08/12/2015] [Indexed: 11/19/2022]
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79
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Voss RK, Woods TN, Cromwell KD, Nelson KC, Cormier JN. Improving outcomes in patients with melanoma: strategies to ensure an early diagnosis. PATIENT-RELATED OUTCOME MEASURES 2015; 6:229-42. [PMID: 26609248 PMCID: PMC4644158 DOI: 10.2147/prom.s69351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with thin, low-risk melanomas have an excellent long-term prognosis and higher quality of life than those who are diagnosed at later stages. From an economic standpoint, treatment of early stage melanoma consumes a fraction of the health care resources needed to treat advanced disease. Consequently, early diagnosis of melanoma is in the best interest of patients, payers, and health care systems. This review describes strategies to ensure that patients receive an early diagnosis through interventions ranging from better utilization of primary care clinics, to in vivo diagnostic technologies, to new "apps" available in the market. Strategies for screening those at high risk due to age, male sex, skin type, nevi, genetic mutations, or family history are discussed. Despite progress in identifying those at high risk for melanoma, there remains a lack of general consensus worldwide for best screening practices. Strategies to ensure early diagnosis of recurrent disease in those with a prior melanoma diagnosis are also reviewed. Variations in recurrence surveillance practices by type of provider and country are featured, with evidence demonstrating that various imaging studies, including ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging, provide only minimal gains in life expectancy, even for those with more advanced (stage III) disease. Because the majority of melanomas are attributable to ultraviolet radiation in the form of sunlight, primary prevention strategies, including sunscreen use and behavioral interventions, are reviewed. Recent international government regulation of tanning beds is described, as well as issues surrounding the continued use artificial ultraviolet sources among youth. Health care stakeholder strategies to minimize UV exposure are summarized. The recommendations encompass both specific behaviors and broad intervention targets (eg, individuals, social spheres, organizations, celebrities, governments).
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Affiliation(s)
- Rachel K Voss
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tessa N Woods
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate D Cromwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice N Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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80
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Zelken JA, Tufaro AP. Current Trends and Emerging Future of Indocyanine Green Usage in Surgery and Oncology: An Update. Ann Surg Oncol 2015; 22 Suppl 3:S1271-83. [PMID: 26193966 DOI: 10.1245/s10434-015-4743-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Indocyanine green (ICG) is a widely available dye of clinical importance that has been used for more than 50 years. Near-infrared (NIR) ICG fluorescence imaging has found a niche in cancer care since 2005, and was reviewed in 2011. There is a need for a comprehensive update and we aim to provide this through a review of the most recent literature. METHODS A systematic review of the literature using PubMed, EMBASE, and MEDLINE databases of articles published from 2000 to June 2015 evaluated topics pertinent to NIR fluorescence imaging with ICG in the diagnosis and surgical treatment of cancer. Articles previously referenced in a 2011 review and a 2015 meta-analysis were excluded, while articles that referenced future directions and economics were included in this current review. RESULTS Since 2011, the literature has grown exponentially, with significant advances at the molecular level. Significant findings from 89 select articles and 10 reviews, most of which were published between 2011 and 2015, are summarized. Preclinical studies are currently underway investigating tumor-specific fluorescence and targeted therapeutic delivery. The potential for ICG exists at every level of cancer care, from diagnosis to surveillance. CONCLUSION The indications, applications, and potential for ICG have grown exponentially in the past decade; an updated review of the literature is overdue and we present the most comprehensive review to date.
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Affiliation(s)
- Jonathan A Zelken
- Finesse Plastic Surgery, Orange, CA, USA. .,Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Anthony P Tufaro
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, USA
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Factors predictive of pelvic lymph node involvement and outcomes in melanoma patients with metastatic sentinel lymph node of the groin: A multicentre study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2015; 41:823-9. [DOI: 10.1016/j.ejso.2015.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/20/2015] [Indexed: 11/24/2022]
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82
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Rossi CR, Sommariva A. Melanoma. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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83
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Jiang A, Rambhatla P, Eide M. Socioeconomic and lifestyle factors and melanoma: a systematic review. Br J Dermatol 2015; 172:885-915. [PMID: 25354495 DOI: 10.1111/bjd.13500] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/27/2022]
Affiliation(s)
- A.J. Jiang
- Stritch School of Medicine; Loyola University Chicago; Maywood IL U.S.A
| | - P.V. Rambhatla
- Department of Dermatology; Henry Ford Hospital; New Center One; 3031 West Grand Blvd, Suite 800 Detroit MI 48202 U.S.A
| | - M.J. Eide
- Department of Dermatology; Henry Ford Hospital; New Center One; 3031 West Grand Blvd, Suite 800 Detroit MI 48202 U.S.A
- Department of Public Health Sciences; Henry Ford Hospital; New Center One; 3031 West Grand Blvd, Suite 800 Detroit MI 48202 U.S.A
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84
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Video endoscopic inguinal lymphadenectomy for lymph node metastasis from solid tumors. Eur J Surg Oncol 2014; 41:274-81. [PMID: 25583458 DOI: 10.1016/j.ejso.2014.10.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 10/14/2014] [Indexed: 01/24/2023] Open
Abstract
AIM Inguinal lymphadenectomy (IL) is the standard treatment for inguinal lymph node (LN) metastases from genitourinary neoplasm and other cutaneous malignancies. Video endoscopic inguinal lymphadenectomy (VEIL) is emerging as a new modality for treating inguinal LN metastasis, with the aim of reducing post-operative complications. However, the safety and effectiveness of this new approach is still unclear. METHOD A systematic literature review was performed. Patient characteristics, selection criteria, intra-operative data, number of excised LNs and post-operative outcomes were extracted and described for each study. RESULTS Ten series that encompassed data of 236 procedures performed in 168 patients were reviewed. The conversion to traditional IL rates ranged between 0 and 7.7%. Median/mean operation time varied between 60 and 245 min. Wound-related complications and lymphatic collection/seroma ranged between 0 and 13.3% and 4 and 38.4%, respectively. The median/mean number of excised inguinal LNs ranged between 7 and 16. Although only four studies reported a follow-up time longer then 2 years, local recurrence rate was up to 6.6%. CONCLUSIONS VEIL is safe and feasible for experienced surgeons with advanced laparoscopic skills and familiarity with groin anatomy. The post-operative morbidity appears lower compared to the open procedure, mainly for wound/skin related complications. The number of harvested LN and the regional recurrence rate is comparable to that of conventional groin dissection. Before VEIL technique can be considered suitable for routine clinical practice, comparable oncological outcomes and lower post-operative morbidity should be assessed in a randomized controlled trial.
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85
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Dickson JK, Davies A, Rahman S, Sethu C, Smith JRO, Orlando A, Ayers D. Dissections of regional lymph nodes for treatment of skin cancer: predicting annual caseloads that will optimise outcomes. Ann R Coll Surg Engl 2014; 97:52-5. [PMID: 25519267 DOI: 10.1308/003588414x14055925059390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Dissection of regional lymph nodes (RLNs) can lead to significant morbidity and a high prevalence of complications. Published guidance states that these procedures should be carried out by surgeons who are members of a specialist skin multidisciplinary team who carry out a combined minimum of 15 axillary/groin dissections per year. However, there is little evidence to guide this minimum figure of procedures. We report on the burden of service provision and prevalence of complications across the South West of England and Wales. METHODS A 12-month review of dissections of RLNs for skin cancer was undertaken covering five Plastic Surgery Units with a collective catchment of 8.4 million people. Detailed data were collected on patient demographics, pathology, timing of surgery, and prevalence of complications. RESULTS A total of 163 dissections were carried out. Forty-three per cent of patients experienced one or more complication. In that 12-month period, an average of 8 axillary/groin dissections was carried out per surgeon. A funnel plot demonstrated that the prevalence of complications for individual surgeons was within the limit of the plot but, in many cases, this was based only on a relatively small number of procedures per consultant. If surgeons carried out 10 procedures per year, the upper and lower limits on the plot were 73% and 11%, respectively. CONCLUSIONS Funnel plots can provide a useful guide as to whether the prevalence of complications for procedures for individual surgeons lies within acceptable limits. Based on these results, 10 procedures per consultant per year should be sufficient to enable meaningful assessment of the prevalence of complications.
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Affiliation(s)
- J K Dickson
- Department of Plastic Surgery, Frenchay Hospital, Frenchay Park Road, Bristol, UK
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86
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West C, Saleh D, Peach H. Combined clearance of pelvic and superficial nodes for clinical groin melanoma. J Plast Reconstr Aesthet Surg 2014; 67:1711-8. [DOI: 10.1016/j.bjps.2014.08.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/17/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
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87
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Davis JR, Trocha SD, Hale AL, Bartz MJ. Videoscopic inguinal lymphadenectomy in malignant melanoma: safe in pregnancy? J Surg Case Rep 2014; 2014:rju103. [PMID: 25378414 PMCID: PMC4221964 DOI: 10.1093/jscr/rju103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Lymphadenectomy is the standard of care for metastatic melanoma in the inguinal lymph node basin. Historically, open surgery was the only treatment option. However, in recent years, videoscopic inguinal lymphadenectomy (VIL) has become a popular approach as it offers a minimally invasive alternative, provides similar oncologic control and reduces wound complications. Even though the VIL approach is being used more frequently, the patient populations that stand to benefit the most from this approach are still under investigation. Despite continued advances in safety for laparoscopic surgery, many surgeons are hesitant to perform these procedures on pregnant women. In this report, we present a successful VIL in a pregnant patient, describe our technique and demonstrate the safety of performing VIL in expectant mothers. To our knowledge, this case represents the first VIL performed in an expectant mother.
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Affiliation(s)
- James R Davis
- Department of Surgery, Greenville Health System, Greenville, SC, USA
| | - Steven D Trocha
- Department of Surgery, Greenville Health System, Greenville, SC, USA
| | - Allyson L Hale
- Department of Surgery, Greenville Health System, Greenville, SC, USA
| | - Mackenzie J Bartz
- Department of Surgery, Greenville Health System, Greenville, SC, USA
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88
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Weldrick C, Bashar K, O’Sullivan T, Gillis E, Clarke Moloney M, Tang T, Walsh S. A comparison of fibrin sealant versus standard closure in the reduction of postoperative morbidity after groin dissection: A systematic review and meta-analysis. Eur J Surg Oncol 2014; 40:1391-8. [DOI: 10.1016/j.ejso.2014.07.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/25/2014] [Accepted: 07/11/2014] [Indexed: 01/23/2023] Open
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89
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Stuiver M, Westerduin E, ter Meulen S, Vincent A, Nieweg O, Wouters M. Surgical wound complications after groin dissection in melanoma patients – A historical cohort study and risk factor analysis. Eur J Surg Oncol 2014; 40:1284-90. [DOI: 10.1016/j.ejso.2014.01.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 12/30/2013] [Accepted: 01/27/2014] [Indexed: 11/26/2022] Open
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90
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Effectiveness of intraoperative indocyanine-green fluorescence angiography during inguinal lymph node dissection for skin cancer to prevent postoperative wound dehiscence. Surg Today 2014; 45:973-8. [DOI: 10.1007/s00595-014-0996-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/01/2014] [Indexed: 11/25/2022]
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91
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Saphenous vein sparing superficial inguinal dissection in lower extremity melanoma. J Skin Cancer 2014; 2014:652123. [PMID: 25126426 PMCID: PMC4122063 DOI: 10.1155/2014/652123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/22/2014] [Indexed: 12/26/2022] Open
Abstract
Aim. The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative morbidity. The permanent lymphedema is the most devastating long-term complication leading to a significant decrease in the patient's quality of life. In this study we present our experience with modified, saphenous vein sparing, inguinal lymph node dissections for patients with melanoma of the lower extremity. Methods. Twenty one patients (10 women, 11 men) who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity were included in this study. The effects of saphenous vein sparing on postoperative complications were evaluated. Results. We have observed the decreased rate of long-term lymphedema in patients undergoing inguinal lymphadenectomy for the lower extremity melanoma. Conclusion. The inguinal lymphadenectomy with saphenous vein preservation in lower extremity melanoma patients seems to be an oncologically safe procedure and it may offer reduced long-term morbidity.
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92
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Niebling MG, Wevers KP, Suurmeijer AJH, van Ginkel RJ, Hoekstra HJ. Deep lymph node metastases in the groin significantly affects prognosis, particularly in sentinel node-positive melanoma patients. Ann Surg Oncol 2014; 22:279-86. [PMID: 25008028 DOI: 10.1245/s10434-014-3854-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND In order to define patients eligible for only a superficial groin dissection or a combined superficial and deep groin dissection, this study aimed to determine the incidence of deep lymph node metastases (LNM) in patients with melanoma metastasized to the groin, to identify patient and melanoma factors that predict deep nodal involvement, and to analyze the impact of deep nodal involvement on survival and recurrence. METHODS Patients who underwent a combined superficial (inguinal) and deep (iliac and obturator) complete (CLND) or therapeutic lymph node dissection (TLND) of the groin between 1994 and 2012 were analyzed. RESULTS QueryDeep LNM were found in 8 of 62 CLND patients (13 %) and in 21 of 67 TLND patients (31 %). More than three superficial LNM was the only independent predictor for deep LNM in both CLND and TLND patients. The 5-year melanoma-specific survival (MSS) for CLND and TLND patients with deep LNM was 14.3 and 16.6 %, respectively, and was significantly worse (hazard ratio [HR] 3.39, 95 % CI 1.34-8.58, p = 0.010; and HR 2.01, 95 % CI 1.04-3.88, p = 0.039) compared with CLND and TLND patients without deep LNM (5-year MSS: 54.1 and 37.2 %, respectively). Distant recurrence was significantly associated with deep LNM in CLND patients (p = 0.032). CONCLUSIONS The present study showed that LNM in the deep area of the groin are fairly common in both CLND and TLND patients and significantly affect prognosis, especially in CLND patients. The number of superficial LNM is the only factor that was found to predict a finding of deep nodal metastases.
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Affiliation(s)
- M G Niebling
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700, Groningen, The Netherlands
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Koh YX, Chok AY, Zheng H, Xu S, Teo MCC. Cloquet's node trumps imaging modalities in the prediction of pelvic nodal involvement in patients with lower limb melanomas in Asian patients with palpable groin nodes. Eur J Surg Oncol 2014; 40:1263-70. [PMID: 24947073 DOI: 10.1016/j.ejso.2014.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/14/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED Patients with clinically palpable lymph node metastases to the groin are treated with groin dissection to control local disease and stage the malignancy. However, the extent of nodal dissection required to optimize survival rate is controversial. AIM To evaluate the approach to the extent of nodal dissection in advanced lower limb melanomas with clinically palpable inguinal nodes; to review survival outcomes based on the extent of nodal dissection and nodal disease. MATERIALS AND METHODS A prospectively maintained database of 12 patients with lower limb melanoma was analyzed. Cloquet's node was assessed based on the frozen section result which guided the decision to proceed to iliac-obturator dissection. The correlation of the results of the Cloquet's nodes and radiological imaging to the final histological outcome of groin nodal dissection were compared. RESULTS The positive predictive value (PPV) of radiological imaging in identifying pelvic nodal disease was 60%. PPV of a positive or indeterminate frozen section result of Cloquet's node was 71.4%. Notably, all patients with a positive frozen section result for the Cloquet's node had positive pelvic nodal disease. Median DFS for all patients is 26 months (range 3-68 months) and the median OS for all patients is 28.5 months (range 5-68 months). Median DFS for node negative patients was 28 months (range 24-68 months). Median DFS for node positive patients was 20 months (range 3-36 months). CONCLUSION Cloquet's node was shown to be superior to radiological imaging and should be preferentially used to decide on the extent of nodal dissection.
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Affiliation(s)
- Y X Koh
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - A Y Chok
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - H Zheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - S Xu
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - Melissa C C Teo
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore.
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94
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Granzow JW, Soderberg JM, Kaji AH, Dauphine C. Review of Current Surgical Treatments for Lymphedema. Ann Surg Oncol 2014; 21:1195-201. [DOI: 10.1245/s10434-014-3518-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Indexed: 11/18/2022]
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95
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Granzow JW, Soderberg JM, Kaji AH, Dauphine C. An Effective System of Surgical Treatment of Lymphedema. Ann Surg Oncol 2014; 21:1189-94. [DOI: 10.1245/s10434-014-3515-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Indexed: 11/18/2022]
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96
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Oncologic outcomes of patients undergoing videoscopic inguinal lymphadenectomy for metastatic melanoma. J Am Coll Surg 2013; 218:620-6. [PMID: 24560569 DOI: 10.1016/j.jamcollsurg.2013.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Open inguinal lymphadenectomy for regionally metastatic melanoma is associated with a high wound-related morbidity. Videoscopic inguinal lymphadenectomy (VIL) is a minimally invasive approach with fewer wound-related complications, yet its adoption has been hindered by a lack of oncologic outcomes data. STUDY DESIGN Data were prospectively collected on all VILs performed for melanoma from 2008 to 2012 (n = 40) and compared with a retrospective cohort of open superficial inguinal lymphadenectomies from 2005 to 2012 (n = 40). Continuous variables were analyzed with Student's t-test, binomial variables with chi-square, and survival curves using log-rank comparison. RESULTS Median follow-up for patients undergoing VIL was 19.1 months compared with 33.9 months in the open inguinal lymphadenectomy group. There were no statistical differences in demographics (age, sex, body mass index, smoking status, Charlson comorbidity index) or clinicopathologic features (primary site, stage, Breslow depth, ulceration). Lymph node yield was similar (VIL, 12.6; open, 14.2; p = 0.131). Overall recurrence rates were also similar: 27.5% in the VIL group and 30.0% in the open group (p = 0.805). One patient in the VIL group and 2 in the open group suffered recurrence in the nodal basin. Although median survival was not reached in the VIL group, Kaplan-Meier estimates of disease-free survival (p = 0.226) and overall survival (p = 0.308) were similar. In a comprehensive analysis of wound complications including infection, skin necrosis, and seroma, patients undergoing VIL had markedly less morbidity (VIL, 47.5%; open, 80.0%; p = 0.002). CONCLUSIONS Videoscopic inguinal lymphadenectomy is associated with similar oncologic outcomes and markedly reduced wound complications when compared with open inguinal lymphadenectomy. The minimally invasive procedure may be the preferred method for inguinal lymphadenectomy in melanoma.
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97
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Onoda S, Todokoro T, Hara H, Azuma S, Goto A. Minimally invasive multiple lymphaticovenular anastomosis at the ankle for the prevention of lower leg lymphedema. Microsurgery 2013; 34:372-6. [DOI: 10.1002/micr.22204] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 10/16/2013] [Accepted: 10/21/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Onoda
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine, University of Tokyo; Bunkyo-ku Tokyo Japan
| | - Takeshi Todokoro
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine, University of Tokyo; Bunkyo-ku Tokyo Japan
| | - Hisako Hara
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine, University of Tokyo; Bunkyo-ku Tokyo Japan
| | - Shuchi Azuma
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine, University of Tokyo; Bunkyo-ku Tokyo Japan
| | - Aya Goto
- Department of Plastic and Reconstructive Surgery; Graduate School of Medicine, University of Tokyo; Bunkyo-ku Tokyo Japan
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98
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Yamamoto T, Yamamoto N, Yoshimatsu H, Hayami S, Narushima M, Koshima I. Indocyanine green lymphography for evaluation of genital lymphedema in secondary lower extremity lymphedema patients. J Vasc Surg Venous Lymphat Disord 2013; 1:400-405.e1. [DOI: 10.1016/j.jvsv.2013.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/25/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022]
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99
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Martin BM, Master VA, Delman KA. Videoscopic Inguinal Lymphadenectomy for Metastatic Melanoma. Cancer Control 2013; 20:255-60. [DOI: 10.1177/107327481302000403] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Benjamin M. Martin
- Division of Surgical Oncology of the Department of Surgery Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Viraj A. Master
- Department of Urology Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Keith A. Delman
- Division of Surgical Oncology of the Department of Surgery Winship Cancer Institute, Emory University, Atlanta, Georgia
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Early Wound Complications After Inguinal Lymphadenectomy in Penile Cancer: A Historical Cohort Study and Risk-factor Analysis. Eur Urol 2013; 64:486-92. [DOI: 10.1016/j.eururo.2013.02.037] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/25/2013] [Indexed: 11/22/2022]
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