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Laparoscopic iliac and iliofemoral lymph node resection for melanoma

Abstract

Regional lymphadenectomy in the iliac and groin, originally devised by Basset in 1912, is performed for the treatment of melanoma metastatic to this lymphatic basin [1]. Laparoscopic iliac node dissection may be a valuable management option because it allows performance of the same procedure as in open surgery [213] but with significant benefits such as decreased operative morbidity due to decreased surgical trauma, less violation of the abdominal muscles or the inguinal ligament, reduced postoperative pain, and increased patient satisfaction with the cosmetic appearance. The authors’ approach makes use of a laparoscopic technique [14] to offer an alternative to traditionally described lymph node dissection for melanoma. A review of the literature showed few laparoscopic approaches in this context. Jones et al. [15] do not perform the resection en bloc and do not address the iliofemoral lymph node dissection with a combined retroperitoneal technique such as the current authors use. Two authors in the literature use laparoscopy through a transperitoneal approach, with a piecemeal removal of nodes [16, 17]. Delman et al. [18] limit their technique to the inguinal and high femoral basin alone. The video demonstrates the novel use of a laparoscopic method to harvest iliac lymph nodes in combination with a minimally invasive approach to groin dissection for metastatic melanoma. After a laparoscopic resection of these nodes, the authors deliver the iliac nodal contents through the groin using a minimally invasive approach. This approach is highly beneficial to the patient. He is able to leave the hospital significantly earlier than he would have after a traditional open procedure. He can return to his job as a car mechanic within 1 week and is metastasis free at the 9-month follow-up assessment without evidence of lymphocele formation. The authors do not believe that this technique has any significant implication for lymphocele formation compared with an open procedure because in essence, the same resection is being performed. A larger prospective series is necessary to determine lymphocele outcomes.

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References

  1. 1.

    Joseph E, Brobeil A, Glass F, Glass J, Messina J, DeConti R et al (1998) Results of complete lymph node dissection in 83 melanoma patients with positive sentinel nodes. Ann Surg Oncol 5:119–125

  2. 2.

    Karakousis CP, Driscoll DL (1994) Groin dissection in malignant melanoma. Br J Surg 81:1771–1774

  3. 3.

    Karakousis CP, Driscoll DL, Rose B, Walsh DL (1994) Groin dissection in malignant melanoma. Ann Surg Oncol 1:271–277

  4. 4.

    Karakousis CP, Emrich LJ, Driscoll DL, Rao U (1991) Survival after groin dissection for malignant melanoma. Surgery 109:119–126

  5. 5.

    McMasters KM, Wong SL, Edwards MJ, Chao C, Ross MI, Noyes RD et al (2002) Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol 9:137–141

  6. 6.

    McMasters KM, Wong SL, Edwards MJ, Ross MI, Chao C, Noyes RD et al (2001) Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma. Surgery 130:151–156

  7. 7.

    Morton DL, Hoon DS, Cochran AJ, Turner RR, Essner R, Takeuchi H et al (2003) Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastases. Ann Surg 238:538–549 (discussion 49–50)

  8. 8.

    Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK et al (1992) Technical details of intraoperative lymphatic mapping for early-stage melanoma. Arch Surg 127:392–399

  9. 9.

    Reeves ME, Delgado R, Busam KJ, Brady MS, Coit DG (2003) Prediction of nonsentinel lymph node status in melanoma. Ann Surg Oncol 10:27–31

  10. 10.

    Spratt J (2000) Groin dissection. J Surg Oncol 73:243–262

  11. 11.

    Tonouchi H, Ohmori Y, Kobayashi M, Konishi N, Tanaka K, Mohri Y et al (2004) Operative morbidity associated with groin dissections. Surg Today 34:413–418

  12. 12.

    Wagner JD, Corbett L, Park HM, Davidson D, Coleman JJ, Havlik RJ et al (2000) Sentinel lymph node biopsy for melanoma: experience with 234 consecutive procedures. Plast Reconstr Surg 105:1956–1966

  13. 13.

    Wagner JD, Gordon MS, Chuang TY, Coleman JJ III, Hayes JT, Jung SH et al (2000) Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma. Cancer 89:453–462

  14. 14.

    Ballester M, Chereau E, Coutant C, Darai E, Rouzier R (2011) Laparoscopic pelvic lymph node dissection. J Vasc Surg 148:e111–e116

  15. 15.

    Jones WO, Cable RL, Gilling PJ (1995) Laparoscopic pelvic lymphadenectomy for malignant melanoma (case reports). Aust N Z J Surg 65:765–767

  16. 16.

    Picciotto F, Volpi E, Zaccagna A, Siatis D (2003) Transperitoneal laparoscopical iliac lymphadenectomy for treatment of malignant melanoma (clinical trial). Surg Endosc 17:1536–1540

  17. 17.

    Ali-Khan AS, Crundwell M, Stone C (2009) Inguinal lymphadenectomy combined with staging endoscopic pelvic node sampling for stage III melanoma. J Plast Reconstr Aesthet Surg 62:1063–1067

  18. 18.

    Delman KA, Kooby DA, Ogan K, Hsiao W, Master V (2010) Feasibility of a novel approach to inguinal lymphadenectomy: minimally invasive groin dissection for melanoma. Ann Surg Oncol 17:731–737

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Disclosures

Don Hoang, Kurt E. Roberts, Edward Teng, and Deepak Narayan have no conflicts of interests or financial ties to disclose.

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Correspondence to Deepak Narayan.

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Supplementary material 1 (MOV 281344 kb)

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Hoang, D., Roberts, K.E., Teng, E. et al. Laparoscopic iliac and iliofemoral lymph node resection for melanoma. Surg Endosc 26, 3686–3687 (2012). https://doi.org/10.1007/s00464-012-2376-3

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Keywords

  • Iliac node resection
  • Laparoscopy
  • Melanoma
  • Novel technique
  • Pelvic and groin dissection