EXTRAPERITONEAL LAPAROSCOPICALLY ASSISTED ILIOINGUINAL LYMPHADENECTOMY FOR TREATMENT OF MALIGNANT-MELANOMA

Background: Current treatment of malignant melanoma of the leg include s ilioinguinal lymphadenectomy (IIL). Standard open IIL (open IIL) inc ludes sectioning of the inguinal ligament to gain access to the iliac nodes. Extraperitoneal laparoscopic IIL (lap IIL) is a feasible, less aggressive approach. It can be combined with standard superficial lymp hadenectomy for treatment of malignant melanoma. Design: Comparative, prospective, nonrandomized series. Setting: Tertiary care center. Pati ents: Twelve consecutive, unselected patients with malignant melanoma treated with lap IIL (group 1) were compared with 10 consecutive, unse lected patients with malignant melanoma on whom open IIL was performed (group 2). Interventions: Standard open IIL and laparoscopic extraper itoneal iliac lymphadenectomy (lap IIL) plus superficial groin lymphad enectomy. Main Outcome Measures: Operative time, intraoperative compli cations, requirements of analgesia, total volume of lymphatic drainage , number of lymph nodes retrieved, immediate morbidity, hospital stay, and longterm morbidity were evaluated. Results: Operative time was si gnificantly longer for the lap IIL group (group 1) than for the open I IL group (group 2) (177+/-44 vs 140+/-18 minutes, respectively; P<.05) , but no patients in group 1 needed conversion to open surgery or deve loped related complications. Overall lymphatic drainage was significan tly lower in group 1 than in group 2 (615+/-518 mt vs 1393+/-793 mt, r espectively; P<.01). The number of doses of analgesics (13+/-8 vs 31+/ -22, P<.03) and length of postoperative stay (7.3+/-3.3 vs 13+/-5 days , P<.006) were also significantly lower in the laparoscopic group. The overall. number of lymph nodes retrieved was similar in both groups ( 10.2+/-4.6 vs 10+/-3, P=.9). One patient developed a groin hernia of 6 m after open IIL. Conclusions: Laparoscopically assisted IIL offers a less aggressive approach than open IIL and entails less pain and a sh orter hospital stay, as we observed in 2 groups with similar oncologic al results (mainly, a similar number of lymph nodes retrieved) who wer e treated with one procedure or the other. Further research should be done to confirm these preliminary advantages in a prospective randomiz ed trial with long-term follow-up.