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

Journal Article · Sun Dec 15 04:00:00 EST 2019 · Annals of Surgical Oncology (Online)

DOI:https://doi.org/10.1245/S10434-019-07810-0· OSTI ID:22927468

Gyorki, D. ^[1]; Burmeister, B. H. ^[2]; Ainslie, J. ^[1]; Fisher, R.; Iulio, J. Di ^[3]; Smithers, B. M. ^[2]; Hong, A.; Shannon, K.; Scolyer, R. A. ^[4]; Carruthers, S.; Coventry, B. J. ^[5]; Babington, S. ^[6]; Duprat, J. ^[7]; Hoekstra, H. J. ^[8]; Thompson, J. F. ^[4]

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1. University of Melbourne, Division of Cancer Surgery, Peter MacCallum Cancer Centre (Australia)
2. University of Queensland, Princess Alexandra Hospital (Australia)
3. Peter MacCallum Cancer Centre, Centre for Biostatistics and Clinical Trials (Australia)
4. University of Sydney, Melanoma Institute of Australia (Australia)
5. University of Adelaide, Royal Adelaide Hospital (Australia)
6. Christchurch Hospital (New Zealand)
7. Hospital Do Cancer (Brazil)
8. University Medical Centre Groningen (Netherlands)

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/m{sup 2} 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.

• OSTI ID: 22927468
• Journal Information: Annals of Surgical Oncology (Online), Journal Name: Annals of Surgical Oncology (Online) Journal Issue: 13 Vol. 26; ISSN 1534-4681
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
DISEASE INCIDENCE
LYMPH NODES
MELANOMAS
METASTASES
PATIENTS
QUALITY OF LIFE
RADIOTHERAPY
SURGERY
SYMPTOMS