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Transperitoneal laparoscopical iliac lymphadenectomy for treatment of malignant melanoma

  • F. Picciotto
  • E. Volpi
  • A. Zaccagna
  • D. Siatis
Original article

Abstract

Background: Current treatment for melanoma of the lower limb includes excision of the primary tumor with ilioinguinal lymphadenectomy in the case of lymph node metastases. The standard surgical approach includes sectioning of the inguinal ligament to gain access to the iliac nodes. More recently, some authors have reported that extraperitoneal laparoscopically assisted ilioinguinal lymphadenectomy for the treatment of malignant melanoma is feasible and less aggressive than standard open surgery. So far, no publications have described transperitoneal laparoscopic iliac lymphadenectomy (TPLND). Methods: From November 2001 to June 2002, 13 patients with ilioinguinal node melanoma metastases underwent TPLND (stage IIIA in 1 case, IIIB in 5 cases, IIIC in 4 cases, and IV in 3 cases). Results: In all 13 cases, the TPLND and groin dissection was performed correctly. Operative time, intra- and postoperative complications, number of lymph nodes retrieved, immediate morbidity, hospital stay, and feasibility of TPLND were evaluated. Conclusions: This study was conducted to evaluate the feasibility and the preliminary results of TPLND used to manage malignant melanoma of the lower limb. This approach has many advantages over the traditional procedure: less surgical trauma, no incision of the abdominal muscles or the inguinal ligament, and less postoperative pain. Moreover, as compared with extraperitoneal laparoscopically assisted ilioinguinal lymphoadenectomy, it provides an improved view of the operative area, dissection zone, and surrounding structures. Further research is needed to confirm these preliminary results regarding the potential applications of this method for treating malignant metastasis to the lower limb.

Keywords

Ilioinguinal lymphadenectomy Laparoscopic iliac lymphadenectomy Laparoscopy Malignant melanoma Metastatic melanoma 

References

  1. 1.
    Balch, CM, Buzaid, AC, Soong, SJ, Atkins, MB, Cascinelli, N, Coit, DG, Fleming, ID, Gershenwald, JE, Houghton Jr, A, Kirkwood, JM,  et al. 2001Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma.J Clin Oncol1936353648PubMedGoogle Scholar
  2. 2.
    Balch, CM, Cascinelli, N 2001The new melanoma staging system.Tumori87S64S68Google Scholar
  3. 3.
    Balch, CM, Milton, GW 1985Management of regional metastatic melanoma.Lippincott, JB eds. Cutaneous melanoma.Philadelphia98106Google Scholar
  4. 4.
    Baronofsky, ID 1948Techinique of inguinal node dissection.Surgery24555567Google Scholar
  5. 5.
    Cooper, CS, Donovan, JF, Terrell, RB, Cohen, MB, Winfield, HN 1997Hip and knee replacement as a relative contraindication to laparoscopic pelvic lymph node dissection.J Urol158128130PubMedGoogle Scholar
  6. 6.
    Freid, RM, Siegel, D, Smith, AD, Weiss, GH 1998Lymphoceles after laparoscopic pelvic node dissection.Urology51131142PubMedGoogle Scholar
  7. 7.
    Glascock, JM, Winfield, HN, Lund, GO, Donovan, JF, Ping, ST, Griffiths, DL 1996Carbon dioxide homeostasis during transperitoneal or extraperitoneal laparoscopic pelvic lymphadenectomy: a real-time intraoperative comparison.J Endourol10319323PubMedGoogle Scholar
  8. 8.
    Harris, MN, Shapiro, RL, Roses, DF 1995Malignant melanoma: primary surgical management (excision and node dissection) based on pathology and staging.Cancer75715725PubMedGoogle Scholar
  9. 9.
    Janetschek, G, Peschel, R, Hobisch, A, Bartsch, G 2001Laparoscopic retroperitoneal lymph node dissection.J Endourol15449453CrossRefPubMedGoogle Scholar
  10. 10.
    Karakousis, CP 1981Ilioinguinal lymph node dissection.Am J Surg141299303Google Scholar
  11. 11.
    Karakousis, CP 1998Therapeutic node dissections in malignat melanoma.Ann Surg Oncol5473482PubMedGoogle Scholar
  12. 12.
    Karakousis, CP, Driscoll, DL, Rose, B, Walsh, DL 1994Groin dissection in malignant melanoma.Ann Surg Oncol1271277PubMedGoogle Scholar
  13. 13.
    Kavoussi, LR, Sosa, E, Chandhoke, PS, Chodak, G, Clayman, RV, Hadley, HR, Loughlin, KR, Ruckle, HC, Rukstalis, D, Schuessler, W 1993Complications of laparoscopic pelvic lymph node dissection.J Urol149322325PubMedGoogle Scholar
  14. 14.
    Kozlowski, PM, Winfield, HN 2000Laparoscopic lymph node dissection: pelvic and retroperitoneal.Semin Laparosc Surg7150159CrossRefPubMedGoogle Scholar
  15. 15.
    Lecuru, F, Taurell, R 1998Transperitoneal laparoscopic pelvic lymhadenectomy for gynecologic malignancies.Surg Endosc1216CrossRefPubMedGoogle Scholar
  16. 16.
    Pearlman, NW, Robinson, WA, Dreiling, LK, McIntyre Jr, RC, Gonzales, R 1995Modified ilioinguinal node dissection for metastatic melanoma.Am J Surg170647650CrossRefPubMedGoogle Scholar
  17. 17.
    Querleu, D 1993Laparoscopic paraaortic node sampling in gynecologic oncology: a preliminary experience.Gynecol Oncol492429CrossRefPubMedGoogle Scholar
  18. 18.
    Querleu, D, Leblanc, E 1999Transumbelical pelvic lymphadenectomy.Laparoscopic surgery in gynaecological oncology.Blackwell ScienceOxford1726Google Scholar
  19. 19.
    Schaeff, B, Paulucci, V, Thomopoulos, J 1998Port-site recurrences after laparoscopic surgery: a review.Dig Surg15124134CrossRefPubMedGoogle Scholar
  20. 20.
    Scribner Jr, DR, Walker, JL, Johnson, GA, McMeekin, DS, Gold, MA, Mannel, RS 2002Laparoscopic pelvic and paraaortic lymph node dissection in the obese.Gynecol Oncol84426430CrossRefPubMedGoogle Scholar
  21. 21.
    Soulie, M, Salomon, L, Seguin, P, Mervant, C, Mouly, P, Hozneck, A, Antiphon, P, Plante, P, Abbou, CC 2001Multiinstitutional study of complications in 1,085 laparoscopic urologic procedures.Urology58899903CrossRefPubMedGoogle Scholar
  22. 22.
    Soulie, M, Seguin, P, Richeux, L, Mouly, P, Vazzoler, N, Pontonnier, F, Plante, P 2001Urological complications of laparoscopic surgery: experience with 350 procedures at a single center.J Urol16519601963PubMedGoogle Scholar
  23. 23.
    Sterne, GD, Murray, DS, Grimley, RP 1995Ilioinguinal block dissection for malignant melanoma.Br J Surg8210571059PubMedGoogle Scholar
  24. 24.
    Stone, CA, Goodacre, TEE 1995Surgical management of regional lymph nodes in primary cutaneous malignant melanoma.Br J Surg8210151022PubMedGoogle Scholar
  25. 25.
    Trias, M, Targarona, EM, Piulachs, J, Balague, C, Bombuy, E, Espert, JJ, Moral, A, Castel, MT 1998Extraperitoneal laparoscopically assisted ilioinguinal lymphadenectomy for treatment of malignant melanoma.Arch Surg133272274CrossRefPubMedGoogle Scholar
  26. 26.
    Veronesi, U 1989Trattato di chirurgia oncologica, vol 2.UTET Torino, Italy783795Google Scholar
  27. 27.
    Whelean, RL, Sellers, GJ, Allendorf, JD, Laird, D, Bessler, MD, Nowygrod, R, Treat, MR 1996Trocar-site recurrence is unlikely to result from aerosolization of tumor cells.Dis Colon Rectum39S7PubMedGoogle Scholar
  28. 28.
    Winfield, HN, Donovan, JF, See, Wa, Loening, SA, Williams, RD 1991Urological laparoscopic surgery.J Urol146941948PubMedGoogle Scholar
  29. 29.
    Winfield, HN, Donovan Jr, JF, Troxel, SA, Rashid, TM 1995Laparoscopic urologic surgery: the financial realities.Surg Oncol Clin N Am4307314PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • F. Picciotto
    • 1
  • E. Volpi
    • 2
  • A. Zaccagna
    • 1
  • D. Siatis
    • 1
  1. 1.Operative Unit of Surgical DermatologyInstitute for Cancer Research and Treatment, Strada Provinciale 142, Km 3.95, 10060 CandioloItaly
  2. 2.Department of Gynecological OncologyInstitute for Cancer Research and Treatment, Strada Provinciale 142, Km 3.95,10060 CandioloItaly

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