RT Journal
A1 Trias M, Targarona EM, Piulachs J, et al
T1 EXtraperitoneal laparoscopically assisted ilioinguinal lymphadenectomy for treatment of malignant melanoma
JF Archives of Surgery
JO Archives of Surgery
YR 1998
FD March 1
VO 133
IS 3
SP 272
OP 275
DO 10.1001/archsurg.133.3.272
UL http://dx.doi.org/10.1001/archsurg.133.3.272
AB Background 
    Current treatment of malignant melanoma of the leg includes ilioinguinal lymphadenectomy (IIL). Standard open IIL (open IIL) includes sectioning of the inguinal ligament to gain access to the iliac nodes. Extraperitoneal laparoscopic IIL (lap IIL) is a feasible, less aggressive approach. It can be combined with standard superficial lymphadenectomy for treatment of malignant melanoma.Design 
    Comparative, prospective, nonrandomized series.Setting 
    Tertiary care center.Patients 
    Twelve consecutive, unselected patients with malignant melanoma treated with lap IIL (group 1) were compared with 10 consecutive, unselected patients with malignant melanoma on whom open IIL was performed (group 2).Interventions 
    Standard open IIL and laparoscopic extraperitoneal iliac lymphadenectomy (lap IIL) plus superficial groin lymphadenectomy.Main Outcome Measures 
    Operative time, intraoperative complications, requirements of analgesia, total volume of lymphatic drainage, number of lymph nodes retrieved, immediate morbidity, hospital stay, and long-term morbidity were evaluated.Results 
    Operative time was significantly longer for the lap IIL group (group 1) than for the open IIL group (group 2) (177±44 vs 140±18 minutes, respectively; P<.05), but no patients in group 1 needed conversion to open surgery or developed related complications. Overall lymphatic drainage was significantly lower in group 1 than in group 2 (615±518 mL vs 1393±793 mL, repectively; P<.01). The number of doses of analgesics (13±8 vs 31±22, P<.03) and length of postoperative stay (7.3±3.3 vs 13±5 days, P<.006) were also significantly lower in the laparoscopic group. The overall number of lymph nodes retrieved was similar in both groups (10.2±4.6 vs 10±3, P=.9). One patient developed a groin hernia of 6 m after open IIL.Conclusions 
    Laparoscopically assisted IIL offers a less aggressive approach than open IIL and entails less pain and a shorter hospital stay, as we observed in 2 groups with similar oncological results (mainly, a similar number of lymph nodes retrieved) who were treated with one procedure or the other. Further research should be done to confirm these preliminary advantages in a prospective randomized trial with long-term follow-up.