Addition of an Iliac/Obturator Lymph Node Dissection Does Not Improve Nodal Recurrence or Survival in Melanoma

Egger, Michael E.; Brown, Russell E.; Roach, Brent A.; Quillo, Amy R.; Martin, Robert C.G.; Scoggins, Charles R.; Stromberg, Arnold J.; McMasters, Kelly M.

doi:10.1016/j.jamcollsurg.2014.02.019

Cited by 27 publications

(27 citation statements)

References 18 publications

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“…It also seems that ilioinguinal dissection was not associated with superior regional disease control. A previous smaller study of 94 patients reported a regional lymph node recurrence rate of 12 per cent after inguinal dissection compared with 17 per cent after ilioinguinal dissection ( P = 0·66).…”

Section: Discussionmentioning

confidence: 82%

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

Verver

Madu

Ophuis

et al. 2017

British Journal of Surgery

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BackgroundThe optimal extent of groin completion lymph node dissection (CLND) (inguinal or ilioinguinal dissection) in patients with melanoma is controversial. The aim of this study was to evaluate whether the extent of groin CLND after a positive sentinel node biopsy (SNB) is associated with improved outcome.MethodsData from all sentinel node‐positive patients who underwent groin CLND at four tertiary melanoma referral centres were retrieved retrospectively. Baseline patient and tumour characteristics were collected for descriptive statistics, survival analyses and Cox proportional hazards regression analyses.ResultsIn total, 255 patients were included, of whom 137 (53·7 per cent) underwent inguinal dissection and 118 (46·3 per cent) ilioinguinal dissection. The overall CLND positivity rate was 18·8 per cent; the inguinal positivity rate was 15·5 per cent and the pelvic positivity rate was 9·3 per cent. The pattern of recurrence, and 5‐year melanoma‐specific survival, disease‐free survival and distant‐metastasis free survival rates were similar for both dissection types, even for patients with a positive CLND result. Cox regression analysis showed that type of CLND was not associated with disease‐free or melanoma‐specific survival.ConclusionThere was no significant difference in recurrence pattern and survival rates between patients undergoing inguinal or ilioinguinal dissection after a positive SNB, even after stratification for a positive CLND result. An inguinal dissection is a safe first approach as CLND in patients with a positive SNB.

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Section: Discussionmentioning

confidence: 82%

“…Previously reported DFS rates were 54 per cent after inguinal dissection and 61 per cent after ilioinguinal dissection ( P = 0·69). Another study reported no significant differences in pelvic node recurrence‐free survival ( P = 0·80) and DFS ( P = 0·44) between the two dissection types.…”

Section: Discussionmentioning

confidence: 95%

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

Verver

Madu

Ophuis

et al. 2017

British Journal of Surgery

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“…Comparing our study with multi-institutional trials of the open procedure is probably the best comparison for the adequacy of the lymph node count. The mean lymph node count for inguinal lymphadenectomies was 11 in both the MSLT-I trial (Mark Faries, personal communication) and the Sunbelt Melanoma Trial 27 (Table 2). …”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Minimally Invasive Inguinal Lymph Node Dissection in Patients With Melanoma (SAFE-MILND)

et al. 2017

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Background Minimally invasive inguinal lymph node dissection (MILND) is a novel approach to inguinal lymphadenectomy. SAFE-MILND (NCT01500304) is a multicenter, phase I/II clinical trial evaluating the safety and feasibility of MILND for patients with melanoma in a group of surgeons newly adopting the procedure. Methods Twelve melanoma surgeons from 10 institutions without any previous MILND experience, enrolled patients into a prospective study after completing specialized training including didactic lectures, participating in a hands-on cadaveric laboratory, and being provided an instructional DVD of the procedure. Complications and adverse postoperative events were graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events Version 4.0. Results Eighty-seven patients underwent a MILND. Seventy-seven cases (88.5%) were completed via a minimally invasive approach. The median total inguinal lymph nodes pathologically examined (SLN + MILND) was 12.0 (interquartile range 8.0, 14.0). Overall, 71% of patients suffered an adverse event (AE); the majority of these were grades 1 and 2, with 26% of patients experiencing a grade 3 AE. No grade 4 or 5 AEs were observed. Conclusions After a structured training program, high-volume melanoma surgeons adopted a novel surgical technique with a lymph node retrieval rate that met or exceeded current oncologic guidelines and published benchmarks, and a favorable morbidity profile.

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“…In the absence of biopsy-proven iliac or obturator nodal involvement, the role of pelvic lymphadenectomy (PLND) for patients with melanoma is controversial [1–4]. Relative indications include radiographic suspicion of pelvic disease, involvement of three or more inguinal nodes, large (>3 cm) positive inguinal nodes especially with extracapsular extension of disease, or a pelvic sentinel node (SLN) identified on lymphoscintigraphy that was not sampled in the setting of positive inguinal SLNs (Figure 1)[5].…”

Section: Introductionmentioning

confidence: 99%

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

Dossett

Castner

Pow‐Sang

et al. 2016

Journal of the American College of Surgeons

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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.

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Addition of an Iliac/Obturator Lymph Node Dissection Does Not Improve Nodal Recurrence or Survival in Melanoma

Cited by 27 publications

References 18 publications

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

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

Safety and Feasibility of Minimally Invasive Inguinal Lymph Node Dissection in Patients With Melanoma (SAFE-MILND)

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

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