Robotic-Assisted Transperitoneal Pelvic Lymphadenectomy for Metastatic Melanoma: Early Outcomes Compared with Open Pelvic Lymphadenectomy

Abstract

Background In the absence of iliac or obturator nodal involvement, the role of pelvic lymphadenectomy (PLND) for melanoma is controversial, but for select patients long-term survival may be achieved with the combination of superficial inguinal (inguinofemoral) and pelvic lymphadenectomy. Open PLND (oPLND) is often limited in visual exposure and may be associated with significant postoperative pain. Robotic PLND (rPLND) is a minimally invasive technique that provides excellent visualization of the iliac and obturator nodes. Outcomes comparing the open and robotic techniques for have not been previously reported for patients with melanoma. Study Design We reviewed our experience with rPLND for melanoma and compared clinical and pathologic results to oPLND. We evaluated operative times, nodal yield and short-term oncologic outcomes. Results 13 rPLND (2013–2015) (15 attempted, 87% success rate) and 25 oPLND (2010–2015) consecutive cases were completed. PLND was combined with an open inguinofemoral dissection in 8 of 13 (62%) robotic and 17 of 25 (68%) open cases. Median length of stay (LOS) was shorter in the rPLND group with 1.0 versus 3.5 days for pelvic only cases (p<0.001) and 2.5 versus 4.0 days (p<0.001) for combined ilioinguinal cases. Median operative time (227 versus 230 minutes, p=0.96) and nodal yield (11 versus 10 nodes, p=0.53) were not different between rPLND and oPLND. Conclusions rPLND offers a safe, effective minimally invasive approach to resect the pelvic lymph nodes in patients with melanoma, with no significant difference in nodal yield or operative times, but a shorter LOS compared to oPLND.

Comparison of Single-Photon Emission Computed Tomography–Computed Tomography (SPECT/CT) and Conventional Planar Lymphoscintigraphy for Sentinel Node Localization in Patients with Cutaneous Malignancies

“…Alternatively, if the superficial or deep pelvic nodes are positive, they could be dissected with an open or robotic pelvic node dissection or followed with imaging. 22 …”

Complete Inguinal Lymph Node Dissection for Stage III Cutaneous Melanoma in Lower Limb

“…Other studies have established relative indications to associate iliac-obturator node dissection including Radiographic suspicion of pelvic disease, involvement of three or more inguinal nodes, extracapsular tumor extension of inguinal nodes, a large (>3 cm) positive inguino-femoral node, in the case of a positive Cloquet's node whose sensitivity and specificity are highly variable and in patients who have recurrent melanoma of the extremity and have already undergone an inguinofemoral lymphadenectomy [23,[32][33][34][35] Access to the iliac fossa is gained via a transverse incision through the external oblique aponeurosis approximately 5-6 cm above the inguinal ligament. This procedure can be practiced using the robotic-assistance that has been shown to improve visualization of the iliac and obturator nodes, provides equivalent nodal yield and shorter length of stay when compared to the classic technique [36]. In our series we practiced iliac lymph node dissection in association to inguinal lymphadenectomy in 6 patients which represented 33% of the series.…”

“…Concerning popliteal lymph node in patients with melanoma, its incidence is exceedingly rare. In one study examining 4262 patients seen at the Sydney Melanoma Unit during a 30-year period, the incidence of clinical involvement of popliteal nodes was determined to be 0.3% [36]. Thereby, Thompson et al recommends popliteal lymph node dissection only for clinical evidence of metastatic disease in a popliteal node.…”

A Surgical Perspective Report on Melanoma Management

“…For pelvic lymphadenectomy, we use a robotic approach. Although there are limited data on its outcome and efficacy compared with an open approach, studies have shown shorter hospital stay with comparable operating time and nodal yield [23].…”