Inguinal lymphadenectomy for stage III melanoma: a comparative study of two surgical approaches at the onset of lymphoedema.

INTRODUCTION

When sentinel lymph node is positive for metastasis (exclusion for micro-metastasis) and in cases of palpable adenopathy, a lymphadenectomy should be performed. Many incisional surgical approach have been described in literature. We perform two type of incision (vertical with skin excision and transversal) for inguinal lymphadenectomy. The aim of this study was to compare post-operative morbidity between these two approach in cases of Stage III Melanoma. We analysed chronic lymphoedeme, skin necrosis, wound dehiscence, wound infection and seroma rates between the two techniques.

METHODS

From April 2000 to February 2012 fifty-three patients underwent to inguinal lymphadenectomy for Stage III melanoma at CHU of Rennes. Patients were stratified in 2 groups according to the surgical approach, group 1 with a vertical incision with skin excision and group 2 with a transverse incision.

RESULTS

Chronic lymphoedema rate for group 1 was 37.04% and for group 2 rate was 26.92%, this complication was lower un group 2 but no significant difference was observed (p = 0.558). Skin necrosis (p = 0.235), wound dehiscence (p = 1.000), wound infection (p = 0.236) and seroma (p = 0.757) were not significantly different. Two cases of skin necrosis were observed in group 2 (7.69%) and none in group 1.

CONCLUSION

We do not found significant difference for chronic lymphoedema between these two approach. However, we had less lymphoedema with the transversal technique which has the advantage to reduce the skin suffering when external iliac lymphadenectomy dissection is necessary in addition to the inguinal lymphadenectomy.