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      Videoscopic inguinal lymphadenectomy in malignant melanoma: safe in pregnancy?

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          Abstract

          Lymphadenectomy is the standard of care for metastatic melanoma in the inguinal lymph node basin. Historically, open surgery was the only treatment option. However, in recent years, videoscopic inguinal lymphadenectomy (VIL) has become a popular approach as it offers a minimally invasive alternative, provides similar oncologic control and reduces wound complications. Even though the VIL approach is being used more frequently, the patient populations that stand to benefit the most from this approach are still under investigation. Despite continued advances in safety for laparoscopic surgery, many surgeons are hesitant to perform these procedures on pregnant women. In this report, we present a successful VIL in a pregnant patient, describe our technique and demonstrate the safety of performing VIL in expectant mothers. To our knowledge, this case represents the first VIL performed in an expectant mother.

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          Prospective assessment of postoperative complications and associated costs following inguinal lymph node dissection (ILND) in melanoma patients.

          Storm Weaver, Pauline M. Ross, S. Chang … (2010)
          We prospectively assessed the incidence, risk factors, and costs associated with wound complications and lymphedema in melanoma patients undergoing inguinal lymph node dissection (ILND). A total of 53 melanoma patients were accrued to 2 trials (June 2005 to July 2008) that included prospective evaluations of postoperative complications; 30-day wound complications included infection, seroma, and/or dehiscence. There were 20 patients who underwent limb volume measurement and completed a 19-item lymphedema symptom assessment questionnaire preoperatively and 3 months postoperatively. A multivariate analysis was performed to evaluate potential risk factors for complications. A microcosting analysis was also performed to evaluate the direct costs associated with wound complications. The 30-day wound complications were noted in 77.4% of patients. A BMI ≥ 30 (n = 28) increased the risk for wound complications (odds ratio [OR] = 11.4, 95% confidence interval [95%CI] 1.6-78.5, P = .01), while advanced nodal disease approached significance (OR = 9.0, 95%CI: 0.79-103.1, P = .08). Other risk factors, including diabetes, smoking, and the addition of a deep pelvic (iliac/obturator) dissection to ILND, were not significant. Of 20 patients, 9 (45%) developed limb volume change (LVC) ≥5% at 3 months, with associated mean symptom scores of 6.1 versus 4.6 for those without LVC. Costs for patients with wound complications were significantly higher than for those without wound complications. Postoperative wound complications and early onset lymphedema occur frequently following ILND for melanoma. Obesity is an adverse risk factor for 30-day wound complications that can significantly increase postoperative costs, as is likely the case for advanced disease. Risk reduction practices and novel treatment approaches are needed to reduce postoperative morbidity.
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            Radical lymph node dissection for melanoma.

            Jonathan W Serpell, Peter Carne, Michael Bailey (2003)
            Therapeutic lymph node dissection for melanoma aims to achieve regional disease control. Radical lymphadenectomy (RLND) can be a difficult procedure associated with significant postoperative morbidity. The aims of the present study were to review regional disease control and morbidity in a series of lymphadenectomies performed within a specialist unit. The present study involved the analysis of 73 lymphadenectomies in 64 patients, from 1995 to 2001. The overall wound complication rate after inguinal lymphadenectomy (71%) was higher than after axillary lymphadenectomy (47%; P = 0.05). After inguinal lymphadenectomy, the wound infection rate was higher (25.0%vs 5.9%; P = 0.03), delayed wound healing was more frequent (25.0%vs 5.9%; P = 0.03), and the mean time that drain tubes remained in situ was longer (12.5 vs 8.2 days; P = 0.05). There were no significant differences in seroma (46%vs 32%) rates. Lymphoedema was more common after inguinal lymphadenectomy (P < 0.02). Multivariate analysis identified inguinal RLND (P = 0.002) and increasing tumour size (P = 0.045) as predictors of wound morbidity. More patients received postoperative radiotherapy after neck RLND compared to inguinal or axilla RLND (P = 0.03). Six (8%) patients developed local recurrence after lymphadenectomy. At a median follow up of 22 months, 34 (53%) patients have died, from disseminated disease. Radical lymphadenectomy for melanoma is associated with significant morbidity. Inguinal node dissection has a higher rate of complications than axillary dissection. Low local recurrence rates can be achieved, limiting the potential morbidity of uncontrolled regional metastatic disease.
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              Oncologic outcomes of patients undergoing videoscopic inguinal lymphadenectomy for metastatic melanoma.

              Benjamin M Martin, Joanna W Etra, Maria Russell … (2014)
              Open inguinal lymphadenectomy for regionally metastatic melanoma is associated with a high wound-related morbidity. Videoscopic inguinal lymphadenectomy (VIL) is a minimally invasive approach with fewer wound-related complications, yet its adoption has been hindered by a lack of oncologic outcomes data.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (iso-abbrev): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Journal ID (hwp): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: November 2014
                Publication date (Electronic): 06 November 2014
                Volume: 2014
                Issue: 11
                Electronic Location Identifier: rju103
                Affiliations
                Department of Surgery, Greenville Health System , Greenville, SC, USA
                Author notes
                [* ]Correspondence address. Department of Surgery, Greenville Health System, 701 Grove Road, Greenville, SC 29605, USA. Tel: +1-864-608-8150; Fax: +1-864-455-1320; E-mail: jdavis9@ 123456ghs.org
                Article
                Publisher ID: rju103
                DOI: 10.1093/jscr/rju103
                PMC ID: 4221964
                SO-VID: 13f2427d-c7a3-40f3-9ff0-eaf470c91cd4
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2014.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 6 August 2014
                Date revision received : 15 September 2014
                Date accepted : 18 September 2014
                Page count
                Pages: 2
                Categories
                Subject: Case Reports
                Subject: 070

                Data availability:

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