Videoscopic Inguinal Lymphadenectomy for Metastatic Melanoma

Benjamin M. Martin, MD; Viraj A. Master, MD, PhD; Keith A. Delman, MD

Disclosures

Cancer Control. 2013;20(4):255-260. 

In This Article

Results

We previously reported our initial experience in 32 patients undergoing 45 procedures to establish the feasibility of VIL.[6,21] Of these procedures, 18 dissections (40%) were for melanoma, 19 (42%) for penile carcinoma, 4 (9%) for scrotal/urethral carcinoma, and 4 (9%) for other pathologies. The median patient age was 61 years (range, 16–87) and median body mass index was 30 kg/m2 (range, 19–53). Eighty-nine percent of the patients with melanoma had primary disease located in the extremities, with a median Breslow depth of 2.8 mm (range, 0.6–9.9). Ulceration was present in 8 of these patients (44%). The diagnosis of regionally metastatic melanoma was accomplished by sentinel lymph node biopsy in 13 patients (72%). Median operative time for VIL was 165 minutes (range, 75–245). Two (4%) of the procedures were converted to an open approach. The first conversion occurred for high end-tidal CO2 levels, and the other transpired in a patient with restricted hip mobility and clinically palpable lymphadenopathy. The median node count was 11 (range, 4–24), with the largest node removed being 5.6 cm. Median drain duration was 15 days (range, 7–25).

Detailed data from complications have been previously reviewed.[24,25] The most common complication was readmission for the administration of intravenous antibiotics in 10.5% of patients. One patient (2.6%) experienced flap necrosis, which was conservatively managed with negative pressure wound therapy. Mild to moderate lymphedema occurred in 7.8% of patients; 2 of these required compressive stockings for symptomatic treatment. No episodes of wound dehiscence were noted following VIL (Fig 5).[24]

Figure 5.

The same patient in Fig 1 is shown with a right-sided wound dehiscence following open lymphadenectomy. This patient also underwent left-sided videoscopic inguinal lymphadenectomy for penile carcinoma.

Other reports have also concluded VIL to be a viable alternative to the standard open technique for melanoma patients. Abbott et al[26] published their VIL experience in a cohort of 13 patients, demonstrating a significant reduction in hospital length of stay and increased lymph node harvest when compared with open lymphadenectomy. One patient developed a wound infection and another required readmission for seroma formation. No wound dehiscence was noted.

We are currently reviewing our accumulated VIL experience in 67 patients undergoing 94 procedures for melanoma (n = 37), cutaneous malignancies of the genitourinary area, and lower extremities. It remains to be determined whether equivalent or better lymph node yields for patients undergoing VIL translate to comparable long-term oncological outcomes when compared with the traditional open inguinal lymphadenectomy.

processing....