Comparison of surgical morbidities between LigaSure™ and conventional techniques in inguinal or ilioinguinal lymph node dissection for skin cancer: A single center retrospective study

Abstract

Skin cancer patients with clinical nodal disease or whose positive sentinel nodes had great tumor burden remain candidates for regional lymph node dissections. Among these patients, inguinal or ilioinguinal lymph node dissection is frequently required in clinical practice, which is associated with significant postoperative morbidity—including lymphatic leakage. The aim of this retrospective study was to evaluate the efficacy of LigaSure™, an electrothermal bipolar vessel sealing system, in reducing lymphatic leakage in inguinal or ilioinguinal lymph node dissection. In total, 58 patients who received inguinal or ilioinguinal lymph node dissection (conventional group, 48; LigaSure™ group, 10) and shared similar characteristics were included in this study. Lymphatic leakage after drain removal was significantly lower in the LigaSure™ group than that in the conventional group (present ratio, 0% vs. 37%; p = 0.02). The daily lymphatic drainage volume also tended to be lower in the LigaSure™ than that in the conventional group, with significant differences on postoperative day 1 (p = 0.02). Other perioperative outcomes including the operating time, intraoperative blood loss, time to drain removal, duration of hospital stay, flap necrosis, and wound infection showed no significant differences between the two groups. The use of the LigaSure™ in inguinal or ilioinguinal lymph node dissection for the treatment of skin cancer could reduce the incidence of postoperative lymphatic leakage after drain removal.

A vessel sealing system can help reduce the risk of postoperative complications after tumour resection in the medial thigh

“…In other malignancies such as breast cancer, skin cancer, and vulvar cancer, studies have investigated the usefulness of VSS for lymphadenectomy associated with axillary and ilioinguinal lesions. 16 - 21 They reported that the use of VSS reduced total drainage volume and shortened the durations of continuous suction drainage and hospitalization, 16 , 18 - 20 findings that are consistent with those of our study. Moreover, the use of VSS was shown to reduce the rate of complications.…”

“…Moreover, the use of VSS was shown to reduce the rate of complications. 20,21 Although the incidence of postoperative complication such as seroma, lymphorrhea, and infection, were not reduced by VSS use in our study, we believe that they may have been lower if our sample size was larger. Since VSS is beneficial for lymphatic sealing when dissecting or ligating the adipose tissues rich in lymph vessels, the use of VSS for the resection of STSs arising in the welldeveloped lymphatic drainage system, including not only the medial thigh but also the axillary or ilioinguinal regions, can reduce the rate of lymphatic complications.…”

Current surgical management for melanoma

“…Risk factors for CLND complications include obesity, old age, and inguinal CLND 71,76,80,81 . Lymphocele formation following inguinal CLND is frequently observed in clinical practice 82 …”

“…71,76,80,81 Lymphocele formation following inguinal CLND is frequently observed in clinical practice. 82…”