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Khan M, Kelley J, Wright GP. Starting a minimally invasive inguinal lymphadenectomy program: Initial learning experience and outcomes. Surgery 2023; 173:633-639. [PMID: 36379745 DOI: 10.1016/j.surg.2022.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is promising data on minimally invasive inguinal lymphadenectomy indicating decreased wound complications compared with the standard open approach. We examined our institutional experience with starting a minimally invasive inguinal lymphadenectomy program. METHODS This is a retrospective case series of consecutive patients undergoing videoscopic minimally invasive inguinal lymphadenectomy from August 2017 to March 2022 by a single surgeon. Patients meeting criteria for inguinal lymphadenectomy were considered for minimally invasive inguinal lymphadenectomy unless there was skin involvement by tumor or bulky disease. Data collected included patient characteristics, primary cancer, surgery, and postoperative complications. RESULTS There were 26 patients included. The mean age was 60.6 ± 16.2 years. Most patients were female (n = 17, 65.4%), and the primary diagnosis was melanoma (n = 21, 19.2%). In 6 cases (23.1%), minimally invasive inguinal lymphadenectomy was combined with deep pelvic node dissection, but most patients did not have a concurrent procedure (n = 15, 57.7%). The median operative time was 119.0 minutes (range, 89.0-160.0), or 130.5 minutes (range, 89.0-345.0) when including concurrent procedures. The mean number of nodes retrieved was 9.8 ± 3.7, with a positive node identified in 19 patients (73.1%) during minimally invasive inguinal lymphadenectomy. There were 12 (46.2%) patients experiencing at least one postoperative complication within 30 days of surgery, the most common being infection (n = 4, 15.4%). One patient required reoperation for infected hematoma washout. Postoperative intervention for seroma was undertaken in 3 patients (11.5%). CONCLUSION Minimally invasive inguinal lymphadenectomy is a safe approach to inguinal lymph node dissection, in terms of node retrieval and postoperative complications, and can feasibly be adopted into practice with minimal learning curve.
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Affiliation(s)
- Mariam Khan
- Spectrum Health General Surgery Residency, Grand Rapids, MI.
| | - Jesse Kelley
- Spectrum Health Surgical Oncology, Grand Rapids, MI
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Lattimore CM, Meneveau MO, Marsh KM, Shada AL, Slingluff CL, Dengel LT. A Novel Fascial Flap Technique After Inguinal Complete Lymph Node Dissection for Melanoma. J Surg Res 2022; 278:356-363. [PMID: 35671681 DOI: 10.1016/j.jss.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Inguinal complete lymph node dissection (CLND) for metastatic melanoma exposes the femoral vein and artery. To protect femoral vessels while preserving the sartorius muscle, we developed a novel sartorius and adductor fascial flap (SAFF) technique for coverage. METHODS The SAFF technique includes dissection of fascia off sartorius and/or adductor muscles, rotation over femoral vasculature, and suturing into place. Patients who underwent inguinal CLND with SAFF for melanoma at our institution were identified retrospectively from a prospectively-collected database. Patient characteristics and post-operative outcomes were obtained. Multivariate logistic regression assessed associations of palpable and non-palpable disease with wound complications. RESULTS From 2008 to 2019, 51 patients underwent CLND with SAFF. Median age was 62 years, and 59% were female. Thirty-one (61%) patients were presented with palpable disease and 20 (39%) had non-palpable disease. Fifty-five percent (95% confidence interval CI: 40%-69%) experienced at least one wound complication: wound infection was most common (45%; 95% CI: 31%-60%), while bleeding was the least (2%; 95% CI: 0.05%-11%). Complications were similar, with and without palpable disease. CONCLUSIONS The SAFF procedure covers femoral vessels, minimizes bleeding, preserves the sartorius muscle, and uses standard surgical techniques easily adoptable by surgeons who perform inguinal CLND.
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Affiliation(s)
- Courtney M Lattimore
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Max O Meneveau
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Katherine M Marsh
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Amber L Shada
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Craig L Slingluff
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Lynn T Dengel
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Jakub JW, Lowe M, Howard JH, Farma JM, Sarnaik A, Tuttle T, Neuman HB, Ariyan CE, Uppal A, Trocha S, Beasley GM, Wasif N, Bilimoria KY, Thomay AA, Allred JB, Chen L, Terando AM, Wayne JD, Thompson JF, Cochran AJ, Sim MS, Elashoff DE, Delman KA, Faries MB. Oncologic Outcomes of Multi-Institutional Minimally Invasive Inguinal Lymph Node Dissection for Melanoma Compared with Open Inguinal Dissection in the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II). Ann Surg Oncol 2022; 29:5910-5920. [PMID: 35499783 DOI: 10.1245/s10434-022-11758-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Minimally invasive inguinal lymphadenectomy (MILND) is safe and feasible, but limited data exist regarding oncologic outcomes. METHODS This study performed a multi-institutional retrospective cohort analysis of consecutive MILND performed for melanoma between January 2009 and June 2016. The open ILND (OILND) comparative cohort comprised patients enrolled in the second Multicenter Selective Lymphadenectomy Trial (MSLT-II) between December 2004 and March 2014.The pre-defined primary end point was the same-basin regional nodal recurrence, calculated using properties of binomial distribution. Time to events was calculated using the Kaplan-Meier method. The secondary end points were overall survival, progression-free survival, melanoma-specific survival (MSS), and distant metastasis-free survival (DMFS). RESULTS For all the patients undergoing MILND, the same-basin regional recurrence rate was 4.4 % (10/228; 95 % confidence interval [CI], 2.1-7.9 %): 8.2 % (4/49) for clinical nodal disease and 3.4 % (6/179) for patients with a positive sentinel lymph node (SLN) as the indication. For the 288 patients enrolled in MSLT-II who underwent OILND for a positive SLN, 17 (5.9 %) had regional node recurrence as their first event. After controlling for ulceration, positive LN count and positive non-SLNs at the time of lymphadenectomy, no difference in OS, PFS, MSS or DMFS was observed for patients with a positive SLN who underwent MILND versus OILND. CONCLUSION This large multi-institutional experience supports the oncologic safety of MILND for melanoma. The outcomes in this large multi-institutional experience of MILND compared favorably with those for an OILND population during similar periods, supporting the oncologic safety of MILND for melanoma.
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Affiliation(s)
- James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Michael Lowe
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - J Harrison Howard
- Department of Surgery, University of South Alabama Health, Mobile, AL, USA
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Amod Sarnaik
- Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Todd Tuttle
- Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Heather B Neuman
- Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Abhineet Uppal
- Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Steve Trocha
- Department of Surgery, Greenville Health System, Greenville, SC, USA
| | - Georgia M Beasley
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Nabil Wasif
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Karl Y Bilimoria
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alan A Thomay
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Jacob B Allred
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Lucia Chen
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - Alicia M Terando
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jeffrey D Wayne
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Alistair J Cochran
- Department of Anatomic Pathology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Myung-Shin Sim
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - David E Elashoff
- Department of Medicine Statistics Core, UCLA Medical Center, Los Angeles, CA, USA
| | - Keith A Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark B Faries
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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One-Year Morbidity Following Videoscopic Inguinal Lymphadenectomy for Stage III Melanoma. Cancers (Basel) 2021; 13:cancers13061450. [PMID: 33810068 PMCID: PMC8004993 DOI: 10.3390/cancers13061450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Inguinal lymphadenectomy (the removal of lymph nodes in the groin) is currently part of the treatment options for stage III melanoma patients. Surgery can be performed using one large inguinal incision (open approach) or a few smaller incisions (videoscopic approach). Previous research has already shown less severe complications and comparable oncologic outcomes after the videoscopic approach. Postoperative lymphedema following inguinal lymphadenectomy is a well-known problem which can potentially decrease quality of life. With the arrival of adjuvant systemic treatment options, less invalidating surgery is highly desirable. However, lymphedema and quality of life have only been investigated after the open approach. Therefore, we evaluated lymphedema and quality of life following videoscopic inguinal lymphadenectomy for stage III melanoma. The videoscopic inguinal lymphadenectomy is a feasible approach due to the comparable lymphedema incidence and normalization of quality of life during follow-up. Abstract Purpose: We aimed to elucidate morbidity following videoscopic inguinal lymphadenectomy for stage III melanoma. Methods: Melanoma patients who underwent a videoscopic inguinal lymphadenectomy between November 2015 and May 2019 were included. The measured outcomes were lymphedema and quality of life. Patients were reviewed one day prior to surgery and postoperatively every 3 months for one year. Results: A total number of 34 patients were included for participation; 19 (55.9%) patients underwent a concomitant iliac lymphadenectomy. Lymphedema incidence was 40% at 3 months and 50% at 12 months after surgery. Mean interlimb volume difference increased steadily from 1.8% at baseline to 6.9% at 12 months (p = 0.041). Median Lymph-ICF-LL total score increased from 0.0 at baseline to 12.0 at 3 months, and declined to 8.5 at 12 months (p = 0.007). Twelve months after surgery, Lymph-ICF-LL scores were higher for females (p = 0.021) and patients that received adjuvant radiotherapy (p = 0.013). The Median Distress Thermometer and EORTC QLQ-C30 summary score recovered to baseline at 12 months postoperatively (p = 0.747 and p = 0.203, respectively). Conclusions: The onset of lymphedema is rapid and continues to increase up to one year after videoscopic inguinal lymphadenectomy. Quality of life recovers to the baseline value.
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