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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

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.

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References

  1. Balch CM, Gershenwald JE, Soong S-J, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–206.

    Article  Google Scholar 

  2. Chang SB, Askew RL, Xing Y, Weaver S, Gershenwald JE, Lee JE, et al. Prospective assessment of postoperative complications and associated costs following inguinal lymph node dissection (ILND) in melanoma patients. Ann Surg Oncol. 2010;17(10):2764–72.

    Article  Google Scholar 

  3. Sabel MS, Griffith KA, Arora A, Shargorodsky J, Blazer DG, Rees R, et al. Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery. 2007;141(6):728–35.

    Article  Google Scholar 

  4. Serpell JW, Carne PW, Bailey M. Radical lymph node dissection for melanoma. ANZ J Surg. 2003;73(5):294–9.

    Article  Google Scholar 

  5. Soderman M, Thomsen JB, Sorensen JA. Complications following inguinal and ilioinguinal lymphadenectomies: a meta-analysis. J Plast Surg Hand Surg. 2016;50(6):315–20.

    Article  Google Scholar 

  6. Van der Ploeg AP, van Akkooi AC, Schmitz PI, van Geel AN, de Wilt JH, Eggermont AM, et al. Therapeutic surgical management of palpable melanoma groin metastases: superficial or combined superficial and deep groin lymph node dissection. Ann Surg Oncol. 2011;18(12):3300–8.

    Article  Google Scholar 

  7. Henderson MA, Burmeister BH, Ainslie J, Fisher R, Di Iulio J, Smithers BM, et al. Adjuvant lymph-node field radiotherapy versus observation only in patients with melanoma at high risk of further lymph-node field relapse after lymphadenectomy (ANZMTG 01.02/TROG 02.01): 6-year follow-up of a phase 3, randomised controlled trial. Lancet Oncol. 2015;16(9):1049–60.

    Article  Google Scholar 

  8. Pasquali S, Spillane AJ, de Wilt JH, McCaffery K, Rossi CR, Quinn MJ, et al. Surgeons’ opinions on lymphadenectomy in melanoma patients with positive sentinel nodes: a worldwide web-based survey. Ann Surg Oncol. 2012;19(13):4322–9.

    Article  Google Scholar 

  9. Burmeister BH, Henderson MA, Ainslie J, Fisher R, Di Iulio J, Smithers BM, et al. Adjuvant radiotherapy versus observation alone for patients at risk of lymph-node field relapse after therapeutic lymphadenectomy for melanoma: a randomised trial. Lancet Oncol. 2012;13(6):589–97.

    Article  Google Scholar 

  10. Common Terminology Criteria for Adverse Events V 2. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcv20_4-30-992.pdf. Accessed 25 Feb 2019.

  11. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31(5):1341–6.

    CAS  Article  Google Scholar 

  12. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.

    CAS  Article  Google Scholar 

  13. R Core Team. R Version 3.5.1: A language and environment for statistical computing.

  14. De Vries M, Vonkeman WG, van Ginkel RJ, Hoekstra HJ. Morbidity after inguinal sentinel lymph node biopsy and completion lymph node dissection in patients with cutaneous melanoma. Eur J Surg Oncol. 2006;32(7):785–9.

    Article  Google Scholar 

  15. Stuiver MM, Westerduin E, Meulen S ter, Vincent AD, Nieweg OE, Wouters MW. Surgical wound complications after groin dissection in melanoma patients—a historical cohort study and risk factor analysis. Eur J Surg Oncol. 2014;40(10):1284–90.

    CAS  Article  Google Scholar 

  16. Poos HPAM, Kruijff S, Bastiaannet E, van Ginkel RJ, Hoekstra HJ. Therapeutic groin dissection for melanoma: risk factors for short term morbidity. Eur J Surg Oncol. 2009;35(8):877–83.

    CAS  Article  Google Scholar 

  17. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer. 2010;116(22):5138–49.

    Article  Google Scholar 

  18. Hyngstrom JR, Chiang Y-J, Cromwell KD, Ross MI, Xing Y, Mungovan KS, et al. Prospective assessment of lymphedema incidence and lymphedema-associated symptoms following lymph node surgery for melanoma. Melanoma Res. 2013;23(4):290–7.

    PubMed  Google Scholar 

  19. Hughes TM, A’Hern RP, Thomas JM. Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma. Br J Surg. 2000;87(7):892–901.

    CAS  Article  Google Scholar 

  20. De Vries M, Hoekstra HJ, Hoekstra-Weebers JE. Quality of life after axillary or groin sentinel lymph node biopsy, with or without completion lymph node dissection, in patients with cutaneous melanoma. Ann Surg Oncol. 2009;16(10):2840–7.

    Article  Google Scholar 

  21. Ul-Mulk J, Holmich LR. Lymph node dissection in patients with malignant melanoma is associated with high risk of morbidity. Dan Med J. 2012;59(6):A4441.

    PubMed  Google Scholar 

  22. Cromwell KD, Chiang YJ, Armer J, Heppner PP, Mungovan K, Ross MI, et al. Is surviving enough? Coping and impact on activities of daily living among melanoma patients with lymphoedema. Eur J Cancer Care (Engl). 2015;24(5):724–33.

    CAS  Article  Google Scholar 

  23. Lee TS, Morris CM, Czerniec SA, Mangion AJ. Does lymphedema severity affect quality of life? Simple question. Challenging answers. Lymphat Res Biol. 2017. https://doi.org/10.1089/lrb.2016.0049.

    Article  Google Scholar 

  24. Shaitelman SF, Cromwell KD, Rasmussen JC, Stout NL, Armer JM, Lasinski BB, et al. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin. 2015;65(1):55–81.

    Article  Google Scholar 

  25. Warren AG, Brorson H, Borud LJ, Slavin SA. Lymphedema: a comprehensive review. Ann Plast Surg. 2007;59(4):464–72.

    CAS  Article  Google Scholar 

  26. Spillane AJ, Saw RPM, Tucker M, Byth K, Thompson JF. Defining lower limb lymphedema after inguinal or ilio-inguinal dissection in patients with melanoma using classification and regression tree analysis. Ann Surg. 2008;248(2):286–93.

    Article  Google Scholar 

  27. Testori A, Soteldo J, Powell B, Sales F, Borgognoni L, Rutkowski P, et al. Surgical management of melanoma: an EORTC Melanoma Group survey. Ecancermedicalscience. 2013;7:294.

    CAS  PubMed  PubMed Central  Google Scholar 

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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.

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

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Correspondence to Michael A. Henderson MD, FRACS.

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Henderson, M.A., Gyorki, D., Burmeister, B.H. et al. Inguinal and Ilio-inguinal Lymphadenectomy in Management of Palpable Melanoma Lymph Node Metastasis: A Long-Term Prospective Evaluation of Morbidity and Quality of Life. Ann Surg Oncol 26, 4663–4672 (2019). https://doi.org/10.1245/s10434-019-07810-0

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  • DOI: https://doi.org/10.1245/s10434-019-07810-0