Skip to main content
SpringerLink
Log in

Lymph node dissection for melanoma using tumescence local anaesthesia: an observational study

  • Clinical Report
  • Published:
European Journal of Dermatology

Abstract

Background

The possibility that tumescence local anaesthesia (TLA) may lead to dissemination of tumour cells in lymph nodes is presently unclear.

Objectives

To evaluate whether infiltration by TLA influences metastatic spread and survival probability, compared to general anaesthesia (GA), based on lymph node dissection in melanoma patients.

Patients & methods

In total, 281 patients (GA: 162; TLA: 119) with cutaneous melanoma and clinically or histologically-confirmed metastases in regional lymph nodes were included. All patients underwent complete lymph node dissection.

Results

Median follow-up was 70 months. The rate of lymph node recurrence at the dissection site was 25.3% in the GA group and 17.6% in the TLA group (p = 0.082). No significant difference was found concerning 10-year melanoma-specific survival (GA: 56.2%, TLA: 67.4%; p = 0.09), disease-free survival (GA: 72.8 %, TLA: 81.1%; p = 0.095), or lymph node-free survival (GA: 72.8%, TLA: 81.1%; p = 0.095). Distant metastases-free survival appeared to be slightly reduced in the TLA group (GA: 49.9%, TLA: 64.0%; p = 0.025).

Conclusions

No differences were identified between the GA and TLA groups regarding prognostic outcome for overall survival or disease-free survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Melamed R, Rosenne E, Shakhar K, Schwartz Y, Abudarham N, Ben-Eliyahu S. Marginating pulmonary-NK activity and resistance to experimental tumor metastasis: suppression by surgery and the prophylactic use of a beta-adrenergic antagonist and a prostaglandin synthesis inhibitor. Brain Behav Immun 2005; 19: 114–26.

    Article  PubMed  CAS  Google Scholar 

  2. Ben-Eliyahu S. The promotion of tumor metastasis by surgery and stress: immunological basis and implications for psychoneuroimmunology. Brain Behav Immun 2003; 17: S27–36.

    Article  PubMed  CAS  Google Scholar 

  3. Gottschalk A, Sharma S, Ford J, Durieux ME, Tiouririne M. Review article: the role of the perioperative period in recurrence after cancer surgery. Anesth Anal 2010; 110: 1636–43.

    Article  Google Scholar 

  4. Breuninger H, Schimek F, Heeg P. Subcutaneous infusion anesthesia with diluted mixtures of prilocain and ropivacain. Langenbecks Arch Surg 2000; 385: 284–9.

    Article  PubMed  CAS  Google Scholar 

  5. Schlagenhauff B, Ellwanger U, Breuninger H, Stroebel W, Rassner G, Garbe C. Prognostic impact of the type of anaesthesia used during the excision of primary cutaneous melanoma. Melanoma Res 2000; 10: 165–9.

    Article  PubMed  CAS  Google Scholar 

  6. Seebacher C, Heubaum F, Küster P, Steinert W, Koch R. Comparative analysis of narcosis and local anesthesia in surgery of malignant melanoma of the skin. Hautarzt 1990; 41: 137–41.

    PubMed  CAS  Google Scholar 

  7. Gottschalk A, Brodner G, Van Aken HK, Ellger B, Althaus S, Schulze HJ. Can regional anaesthesia for lymph-node dissection improve the prognosis in malignant melanoma? Br J Anaesth 2012; 109: 253–9.

    Article  PubMed  CAS  Google Scholar 

  8. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Ass 1999; 94: 496–509.

    Article  Google Scholar 

  9. Melchi CF. Prognostic value of anesthesia type for patients treated for cutaneous melanoma. Dermatol Surg 1995; 21: 786–8.

    PubMed  CAS  Google Scholar 

  10. Cakmakkaya OS, Kolodzie K, Apfel CC, Pace NL. Anaesthetic techniques for risk of malignant tumour recurrence. Cochrane Database Syst Rev 2014; 11: CD008877.

    Google Scholar 

  11. Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaest 2010; 105: 106–15.

    Article  CAS  Google Scholar 

  12. Heaney A, Buggy DJ. Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis? Br J Anaesth 2012; 109: i17–28.

    Article  PubMed  Google Scholar 

  13. Eichhorn K, Renner R, Frithjof Haustein U. Sentinel node biopsy in melanoma of the trunk and the extremities in tumescent local anesthesia. Dermatol Surg 2004; 30: 253–6.

    PubMed  Google Scholar 

  14. Stoffels I, Dissemond J, Körber A, et al. Reliability and costeffectiveness of sentinel lymph node excision under local anaesthesia versus general anaesthesia for malignant melanoma: a retrospective analysis in 300 patients with malignant melanoma AJCC Stages I and II. J Eur Acad Dermatol Venereol 2011; 25: 306–10.

    Article  PubMed  CAS  Google Scholar 

  15. Cho E, Rosner BA, Colditz GA. Risk factors for melanoma by body site. Cancer Epidemiol Biomarkers Prev 2005; 14: 1241–4.

    Article  PubMed  Google Scholar 

  16. Caini S, Gandini S, Sera F, et al. Meta-analysis of risk factors for cutaneous melanoma according to anatomical site and clinicopathological variant. Eur J Cancer 2009; 45: 3054–63.

    Article  PubMed  Google Scholar 

  17. Breuninger H, Wehner-Caroli J. Subcutaneous infusion anesthesia with prilocaine diluted with Ringer’s lactate. Hautarzt 1998; 49: 709–13.

    Article  PubMed  CAS  Google Scholar 

  18. Klein JA. The tumescent technique, Anesthesia and modified liposuction technique. Dermatol Clin 1990; 8: 425–37.

    Article  PubMed  CAS  Google Scholar 

  19. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127: 392–9.

    Article  PubMed  CAS  Google Scholar 

  20. Luger TJ, Kammerlander C, Luger MF, Kammerlander-Knauer U, Gosch M. Mode of anesthesia, mortality and outcome in geriatric patients. Z Gerontol Geriatr 2014; 47: 110–24.

    Article  PubMed  CAS  Google Scholar 

  21. Seitz DP, Gill SS, Bell CM, et al. Postoperative medical complications associated with anesthesia in older adults with dementia. J Am Geriatr Soc 2014; 62: 2102–9.

    Article  PubMed  Google Scholar 

  22. Bryczkowski SB, Lopreiato MC, Yonclas PP, Sacca JJ, Mosentha AC. Risk factors for delirium in older trauma patients admitted to the surgical intensive care unit. J Trauma Acute Care Surg 2014; 77: 944–51.

    Article  PubMed  Google Scholar 

  23. Monk TG, Price CC. Postoperative cognitive disorders. Curr Opin Crit Care 2011; 17: 376–81.

    Article  PubMed  Google Scholar 

  24. Hussain M, Berger M, Eckenhoff RG, Seitz DP. General anesthetic and the risk of dementia in elderly patients: current insights. Clin Interv Aging 2014; 9: 1619–28.

    PubMed  PubMed Central  Google Scholar 

  25. Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 2017; 276: 2211–22.

    Article  Google Scholar 

  26. Leiter U, Stadler C, Mauch W, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol 2016; 17: 757–67.

    Article  PubMed  Google Scholar 

  27. Tavare AN, Perry NJS, Benzonana LL, Takata M, Ma D. Cancer recurrence after surgery: direct and indirect effects of anesthetic agents. Int J Cancer 2012; 130: 1237–50.

    Article  PubMed  CAS  Google Scholar 

  28. Paget S. The distribution of secondary growths in cancer of the breast. Cancer Metastatic Rev 1989; 8: 98–101.

    CAS  Google Scholar 

  29. Smyth MJ, Godfrey DI, Trapani JA. A fresh look at tumor immunosurveillance and immunotherapy. Nat Immunol 2001; 2: 293–9.

    Article  PubMed  CAS  Google Scholar 

  30. Takeuchi H, Maehara Y, Tokunaga E, Koga T, Kakeji Y, Sugimachi K. Prognostic significance of natural killer cell activity in patients with gastric carcinoma: a multivariate analysis. Am J Gastroenterol 2001; 96: 574–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Dermatooncology and Department of Dermatology, Eberhard-Karls-University of Tuebingen, Tübingen, Germany

    Lukas Kofler, Helmut Breuninger, Hans-Martin Häfner, Katrin Schweinzer, Saskia M. Schnabl, Thomas K. Eigentler & Ulrike Leiter

Authors
  1. Lukas Kofler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helmut Breuninger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hans-Martin Häfner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katrin Schweinzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Saskia M. Schnabl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas K. Eigentler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ulrike Leiter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulrike Leiter.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kofler, L., Breuninger, H., Häfner, HM. et al. Lymph node dissection for melanoma using tumescence local anaesthesia: an observational study. Eur J Dermatol 28, 177–185 (2018). https://doi.org/10.1684/ejd.2018.3250

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1684/ejd.2018.3250

Key words

Search

Navigation