Therapeutic Surgical Management of Palpable Melanoma Groin Metastases: Superficial or Combined Superficial and Deep Groin Lymph Node Dissection

Abstract

BackgroundManagement of patients with clinically detectable lymph node metastasis to the groin is by ilioinguinal or combined superficial and deep groin dissection (CGD) according to most literature, but in practice superficial groin dissection (SGD) only is still performed in some centers. The aim of this study is to evaluate the experience in CGD versus SGD patients in our center.MethodsBetween 1991 and 2009, 121 therapeutic CGD and 48 SGD were performed in 169 melanoma patients with palpable groin metastases at our institute. Median follow-up was 20 and, for survivors, 45 months.ResultsIn this heterogeneous group of patients, overall (OS) and disease-free survival, local control rates, and morbidity rates were not significantly different between CGD and SGD patients. However, CGD patients had a trend towards more chronic lymphedema. Superficial lymph node ratio, the number of positive superficial lymph nodes, and the presence of deep nodes were prognostic factors for survival. CGD patients with involved deep lymph nodes (24.8%) had estimated 5-year OS of 12% compared with 40% with no involved deep lymph nodes (p = 0.001). Preoperative computed tomography (CT) scan had high negative predictive value of 91% for detection of pelvic nodal involvement.ConclusionsThis study demonstrated that survival and local control do not differ for patients with palpable groin metastases treated by CGD or SGD. Patients without pathological iliac nodes on CT might safely undergo SGD, while CGD might be reserved for patients with multiple positive nodes on SGD and/or positive deep nodes on CT scan.

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

“…In contrast, pelvic positivity rates of approximately 30 per cent have been reported in patients with palpable disease. However, even in these patients the extent of surgery does not seem to affect outcome. Many patients, both those with a positive SNB and those with palpable disease, who undergo ilioinguinal dissection are therefore exposed to a potentially higher risk of morbidity but may not benefit from any therapeutic effect.…”

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]. [30]).…”

“…Eine iliakale Dissektion müsste demnach nur dann durchgeführt werden, wenn LK-Vergrößerungen im Bereich des kleinen Beckens mithilfe einer bildgebenden Methode, z. B. der Computertomografie diagnostiziert werden [3,5]. Fälle von Langzeitüberleben nach pelviner Metastasierung wurden vorwiegend für Patienten mit ausschließlich mikroskopischer (klinisch okkulter) Metastasierung oder für Patienten mit "Skip-Metastasen" im kleinen Becken (iliakale LKM ohne vorgeschaltete inguinale LKM) beschrieben [6,7].…”

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

“…This can be associated with limited visualization - especially for the obturator nodes - and is often associated with significant postoperative pain. oPLND typically requires 4–6 weeks of convalescence and may be complicated by wound infection, ileus or incisional hernia [9]. Postoperative pain may also limit early ambulation and contribute to increased risks of deep venous thrombosis, though the complications of oPLND are poorly characterized.…”