One-Year Morbidity Following Videoscopic Inguinal Lymphadenectomy for Stage III Melanoma

Abstract

Purpose: We aimed to elucidate morbidity following videoscopic inguinal lymphadenectomy for stage III melanoma. Methods: Melanoma patients who underwent a videoscopic inguinal lymphadenectomy between November 2015 and May 2019 were included. The measured outcomes were lymphedema and quality of life. Patients were reviewed one day prior to surgery and postoperatively every 3 months for one year. Results: A total number of 34 patients were included for participation; 19 (55.9%) patients underwent a concomitant iliac lymphadenectomy. Lymphedema incidence was 40% at 3 months and 50% at 12 months after surgery. Mean interlimb volume difference increased steadily from 1.8% at baseline to 6.9% at 12 months (p = 0.041). Median Lymph-ICF-LL total score increased from 0.0 at baseline to 12.0 at 3 months, and declined to 8.5 at 12 months (p = 0.007). Twelve months after surgery, Lymph-ICF-LL scores were higher for females (p = 0.021) and patients that received adjuvant radiotherapy (p = 0.013). The Median Distress Thermometer and EORTC QLQ-C30 summary score recovered to baseline at 12 months postoperatively (p = 0.747 and p = 0.203, respectively). Conclusions: The onset of lymphedema is rapid and continues to increase up to one year after videoscopic inguinal lymphadenectomy. Quality of life recovers to the baseline value.

Quality of Life Predictors in Patients With Melanoma: A Machine Learning Approach

“…In addition, pain at the site of lymph node surgery, and cellulitis of the limb certainly have been reported to increase the risk of lymphedema (42). Given the high number of patients developing lymphedema after inguinal lymph node dissection (ILND), the impact of these chronic issues related to the quality of life and infection on the health care system is not trivial (43,44). A greater number of lower limb lymphedema symptoms and higher severity may catalyze those negative effects, indicating that proper management of modifiable factors may have a positive impact on patient health and well-being (36).…”

Combined robotic inguinal and iliac‐obturator lymphadenectomy for stage III skin cancers: Surgical technique and preliminary results

“…Over the past few years, several groups ‐ including ourselves ‐ reported their experience with miniinvasive approaches to skin cancers, mostly videoscopic, showing optimal functional and cancer‐related outcomes 4‐7 . In fact, avoiding large incisions reduces the chance of wound‐related morbidity, without impairing accurate dissections 4‐6 .…”

“…Over the past few years, several groups -including ourselvesreported their experience with miniinvasive approaches to skin cancers, mostly videoscopic, showing optimal functional and cancerrelated outcomes. [4][5][6][7] In fact, avoiding large incisions reduces the chance of wound-related morbidity, without impairing accurate dissections. [4][5][6] Thanks to the rapid expansion of robotic surgery, preliminary enthusiastic results have been recently reported for isolated pelvic or inguinal basin.…”

“…In particular, ilio‐inguinal dissection is historically associated with wound complications, lymphatic fistulas, seroma/lymphocele formation and chronic lymphoedema, with prolonged in‐hospital stay and severe impairment in quality of life 3‐5 . In order to overcome these criticisms, novel minimally invasive alternatives to the conventional open approach have been introduced, including videoscopic inguinal and iliac‐obturator lymphadenectomy (VIIOL), alone or in combination 4‐7 . As discussed in our single‐institution experience, a combined VIIOL minimises surgical morbidity and accelerates recovery of daily activities, maintaining appropriate oncologic outcomes 6 …”

“…[3][4][5] In order to overcome these criticisms, novel minimally invasive alternatives to the conventional open approach have been introduced, including videoscopic inguinal and iliac-obturator lymphadenectomy (VIIOL), alone or in combination. [4][5][6][7] As discussed in our single-institution experience, a combined VIIOL minimises surgical morbidity and accelerates recovery of daily activities, maintaining appropriate oncologic outcomes. 6 With the effort to improve stage III melanoma and more generally stage III skin cancers oncological care, a paucity of papers on robotic approach have been recently published, but the reported experiences only concern isolated pelvic [8][9][10][11] or inguinal dissections.…”