Morbidity and oncologic outcome after saphenous vein-sparing inguinal lymphadenectomy in melanoma patients

Johannes Baur,Gerhard Weyandt,Jörg O. W. Pelz,Armin Wiegering,Anja Gesierich,Christoph-Thomas Germer,Katrin Mathe,Martin Gasser

doi:10.1186/s12957-017-1164-x

Johannes Baur, Gerhard Weyandt + Show 6 more

Open Access

https://doi.org/10.1186/s12957-017-1164-x

Copy DOI

Abstract

BackgroundInguinal lymph node dissection (LND) is a surgical procedure with a high morbidity rate. Variations in surgical procedure, such as sparing of the saphenous vein, have been proposed to reduce surgical morbidity. While sparing of the saphenous vein has shown promising results in earlier studies, data for this procedure in melanoma patients are rare. In this retrospective study, we report 10-year findings on the effects of saphenous vein-sparing LND on surgical morbidity and oncologic outcomes in melanoma patients.MethodsA retrospective analysis of melanoma patients receiving inguinal LND in our facility between 2003 and 2013 was performed. Patients were divided into two groups: the saphenous vein resection group and the vein sparing group. Surgical morbidity, including wound infection, lymphatic fistula, severe bleeding, neurological complications, and chronic lymphedema, as well as regional recurrence-free survival were investigated.ResultsA total of 106 patients were included in this study; of these, the saphenous vein was spared in 41 patients (38.7%). The rate of lymphatic fistula was 51.6 vs. 48.8%, wound infection occurred in 31.3 vs. 24.4%, and patients suffered from chronic lymphedema in 30.0 vs. 26.5% in V. saphena magna resection vs. sparing group. Differences observed, however, were not significant. No difference in regional recurrence-free survival between the two study groups was detected.ConclusionsThe results of our retrospective analysis could not confirm the promising results reported in earlier studies. Thus, sparing of the saphenous vein appears to be optional.

Highlights

Inguinal lymph node dissection (LND) is a surgical procedure with a high morbidity rate
In patients suffering from malignant melanoma, the standard treatment protocol is wide excision of the primary tumor followed by sentinel lymph node biopsy (SLNB) from the draining lymphatic basin if the tumor is ≥1 mm thick and complete inguinal lymph node dissection (LND) if metastatic involvement of the sentinel node is found
Patients Patients treated at our facility for malignant melanoma between 2003 and 2013 were investigated retrospectively and included in the study if (1) they suffered from melanoma of the trunk or the legs; (2) they received regional inguinal LND; (3) they received LND with curative intention; (4) vena saphena magna was mentioned in their operative report and the vein has not been resected in any previous surgical procedure, and (5) no in-transit or distant metastases was detected at the time LND was performed

Summary

Introduction

Inguinal lymph node dissection (LND) is a surgical procedure with a high morbidity rate. Variations in surgical procedure, such as sparing of the saphenous vein, have been proposed to reduce surgical morbidity. While sparing of the saphenous vein has shown promising results in earlier studies, data for this procedure in melanoma patients are rare. In this retrospective study, we report 10-year findings on the effects of saphenous vein-sparing LND on surgical morbidity and oncologic outcomes in melanoma patients. Many variations in surgical technique, such as sartorius transposition or saphenous vein-sparing LND, have been proposed to reduce procedural morbidity [7, 8].

Methods

Results

Discussion

Conclusion