1. Videoscopic ilioinguinal lymphadenectomy for lymph node metastases from melanoma
A. Sommariva, S. Pasquali, C. Cona, L. Saadeh, LG. Campana, M. Meroni, CR Rossi
Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy.
P231
Background: Ilioinguinal lymph node (LN) dissection for melanoma patients is associated with a high rate of wound related morbidity, including infection, dehiscence/necrosis and seroma/lymphocele. Videoscopic groin lymphadenectomy has recently been proposed for treating LN metastases from melanoma with the main goal of reducing post-operative wound-related morbidity through the virtual elimination of surgical incision. This was a prospective single centre trial aimed at investigating feasibility, safety and postoperative outomes of videoscopic ilioinguinal lymphadenectomy (VIIL) in patients with inguinal melanoma LN metastases
Methods: The trial was conducted under an approved protocol reviewed by the local Ethics Committee. Patients without distant metastasis and either positive SLNB or clinically positive inguinal LNs were prospectively enrolled.
The inguinal step was performed via three trocars positioned at the apex of the femoral triangle. After subcutaneous inflation, a formal inguinal LN dissection was performed.
For the iliac step, after insertion of three trocars in the pro-peritoneal space along the midline and creation of pneumo-pelvis, the external iliac and obturator LNs were excised. Clinicopathologic and postoperative outcome data were recorded.
Post-operative
complications
Grade I
N (%)
Grade II
Grade III A-B
Total
Infection
3 (12)
1 (4)
4 (17)
Seroma
2 (8)
5 (21)
7 (29)
Wound dehiscence
Bleeding
Results: Between September 2011 and June 2014, 24 VIIL were performed. Median duration of surgery was 270 minutes (IQR ). Conversion to open dissection occurred in 4 patients (16.6%). Conversion did not occurr during the final 10 procedures. Blood loss was minimal and blood transfusions were never required. The median number of excised LNs was 21 (IQR, 15-25). After a median follow-up of 18 months, regional LN recurrence was observed in two patients (8.3%). No significant impairment in global QoL was observed.
Conclusions: This prospective trial demonstrated the technical feasibility, safety profile and favourable post-operative outcomes of VIIL for melanoma patients with groin LN metastases. Before considering VIIL in clinical practice, this technique should be compared with open surgery within prospective randomized trials.