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Inguinal and Ilio-inguinal Lymphadenectomy in Management of Palpable Melanoma Lymph Node Metastasis: A Long-Term Prospective Evaluation of Morbidity and Quality of Life

  • Michael A. HendersonEmail author
  • D. Gyorki
  • B. H. Burmeister
  • J. Ainslie
  • R. Fisher
  • J. Di Iulio
  • B. M. Smithers
  • A. Hong
  • K. Shannon
  • R. A. Scolyer
  • S. Carruthers
  • B. J. Coventry
  • S. Babington
  • J. Duprat
  • H. J. Hoekstra
  • J. F. Thompson
Melanoma

Abstract

Purpose

Prospective data are lacking on long-term morbidity of inguinal lymphadenectomy including the influence of extent of surgery, use of radiotherapy, and patient factors. The aim of this study is to evaluate the effects of these factors on patient outcome, quality of life (QOL), regional symptoms, and limb volumes after inguinal or ilio-inguinal lymphadenectomy for melanoma.

Methods

Analysis of the subgroup of patients with inguinal lymph node field relapse of melanoma, treated by inguinal or ilio-inguinal lymphadenectomy in the ANZMTG/TROG randomized trial of adjuvant radiotherapy versus observation.

Results

Sixty-nine patients, 46 having undergone inguinal and 23 ilio-inguinal lymphadenectomy, with median follow-up of 73 months were analyzed. Mean limb volume increased rapidly after surgery (7% by 3 months) and continued to increase for at least another 18 months. Patients with body mass index (BMI) ≥ 25 kg/m2 had greater limb volume increase than normal-weight patients (13.3% versus 6.9%, P = 0.030). QOL improved over the first 18 months, but despite initial improvement, regional symptoms persisted long term. Type of surgery (inguinal or ilio-inguinal lymphadenectomy) had no demonstrably significant effect on limb volume (9.9% versus 13.4%, P = 0.35), QOL (P = 0.68), or regional symptoms (P = 0.65). There was no difference in overall survival between inguinal and ilio-inguinal lymphadenectomy [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.40–1.40, P = 0.43].

Conclusions

Inguinal lymphadenectomy for melanoma is a potentially morbid procedure with significant increases in limb volume. Patients report reasonable QOL but may have ongoing regional symptoms. Overweight/obesity is associated with poorer QOL, increased limb volume, and regional symptoms.

Notes

Acknowledgement

This study was funded by the National Health and Medical Research Council of Australia, Cancer Australia, Melanoma Institute Australia, Cancer Council of South Australia.

Disclosure

No author has any financial interest in the subject of study.

Supplementary material

10434_2019_7810_MOESM1_ESM.docx (270 kb)
Supplementary material 1 (DOCX 269 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Michael A. Henderson
    • 1
    Email author
  • D. Gyorki
    • 1
  • B. H. Burmeister
    • 2
  • J. Ainslie
    • 1
  • R. Fisher
    • 3
  • J. Di Iulio
    • 3
  • B. M. Smithers
    • 2
  • A. Hong
    • 4
  • K. Shannon
    • 4
  • R. A. Scolyer
    • 4
  • S. Carruthers
    • 5
  • B. J. Coventry
    • 5
  • S. Babington
    • 6
  • J. Duprat
    • 7
  • H. J. Hoekstra
    • 8
  • J. F. Thompson
    • 4
  1. 1.Division of Cancer Surgery, Peter MacCallum Cancer CentreUniversity of MelbourneMelbourneAustralia
  2. 2.Princess Alexandra HospitalUniversity of QueenslandBrisbaneAustralia
  3. 3.Centre for Biostatistics and Clinical TrialsPeter MacCallum Cancer CentreMelbourneAustralia
  4. 4.Melanoma Institute of AustraliaUniversity of SydneySydneyAustralia
  5. 5.Royal Adelaide HospitalUniversity of AdelaideAdelaideAustralia
  6. 6.Christchurch HospitalChristchurchNew Zealand
  7. 7.Hospital Do CancerSão PauloBrazil
  8. 8.University Medical Centre GroningenGroningenThe Netherlands

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