Regional Control and Morbidity After Superficial Groin Dissection in Melanoma

Abstract

Background There is no consensus about the optimal extent of surgery for patients with melanoma metastases to inguinal nodes, and this is further complicated by variations in terminology for these dissections. In patients without clinical evidence of iliac metastases, we routinely perform a superficial groin dissection (SGD), which clears node-bearing tissue superficial to the fascia lata. We hypothesized that SGD provides regional tumor control comparable to published experience with deep groin dissection (DGD) and iliac and obturator dissection (IOD), but with less morbidity. Methods A retrospective review of a prospectively collected database evaluated patients undergoing SGD April 1994 through May 2008. Patients with clinical evidence of iliac metastases were excluded. Clinical and pathologic data regarding recurrence and survival were evaluated. Results We identified 53 primary SGD: 27 for clinically palpable disease, and 25 for microscopic disease. Number and percentage of positive nodes were similar between groups. Median followup was 39 months, and two patients had primary recurrence in the groin (one in each group). Two additional patients had concurrent groin and systemic recurrence. Five-year Kaplan-Meier estimates for ipsilateral groin recurrence prior to systemic disease, were similar at 9.7% (SE 6.5) and 7.7% (SE 7.4), for microscopic and palpable disease respectively. Similarly, survival was comparable between groups (73% and 82%). Toxicities were comparable to previously published data. Conclusion SGD provides regional control rates similar to DGD and IOD, for lymph node metastases clinically limited to the groin, whether occult or clinically evident.

Beinschwellungen nach inguinaler und ilioinguinaler Dissektion von Melanommetastasen

“…2 Anatomie der inguinalen und iliakalen Lymphknoten: blau -Nodi lymphatici inguinales superficiales, gelb -Nodi lymphatici inguinales profundae, grün -Nodi lymphatici iliaci, dunkelblau -Nodi lymphatici obturatorii, schwarzRosenmüller-LK unter dem Leistenband (aus [13] [5,6,14,15] und zwischen 13 % und 78 % nach kombinierter ilioinguinaler Lymphadenektomie angegeben [5 -7, 14, 16 -18]. Manche Autoren berichten über tendenziell höhere Schwellungsraten infolge der zusätz-lichen Ausräumung im kleinen Becken [5,16,17] andere bezweifeln, dass der iliakale Anteil der Dissektion die Schwellungsraten erhöht [6,14,19,20].…”

Optimal extent of completion lymphadenectomy for patients with melanoma and a positive sentinel node in the groin

“…Some authors advocate ilioinguinal dissection to optimize regional control and possibly increase survival. Others disagree and advocate an inguinal dissection, especially in patients with low suspicion of pelvic nodal metastasis, because ilioinguinal dissection is believed to be associated with increased morbidity and does not seem to affect outcome.…”

“…The majority of studies comparing these two types of dissection have been limited to those with palpable disease, or did not differentiate between patients with a positive SNB or palpable disease. It has been demonstrated, however, that patients with a positive SNB differ from those with palpable disease in tumour biology, rate of pelvic nodal involvement, recurrence pattern and survival rate.…”

Role of a skin bridge incision and prophylactic incisional negative-pressure wound therapy in the prevention of surgical site infection after inguinal lymph node dissection

“…Compared to the LS incision group, the perioperative bundle group was found to have a statistically significantly higher rate of deep inguinal node dissections in addition to superficial node dissections, and a trend toward a higher proportion of patients with creation of a sartorius flap. Although there is evidence from small studies suggesting no major differences in complication rates between superficial and deep groin dissections, 33,34 deep inguinal node dissections and sartorius flaps do increase the operative time (compared to superficial groin dissections without a sartorius flap), which may increase the risk of SSI. Thus, the true effect of SSI reduction with the perioperative bundle may have been underestimated.…”