Summary
Background
Sentinel lymph node biopsy (SLNB) is an indispensable surgical procedure in staging
and management of intermediate-to-thick melanomas. Although recent studies have demonstrated
that complete lymph node dissection (CLND) does not improve 3-year specific survival,
its utility in increasing the disease-free period and the control of local disease
remains confirmed. The most frequent complication related to CLND is lymphedema, which
may affect up to 20% of patients undergoing CLND. The preventive use of lymphatic-venous
micro-anastomoses could avoid this complication.
Materials and methods
We performed a single-institution retrospective case-control study. CLND was proposed
to all subjects with positive-SLNB; a preventive procedure involving multiple lymphaticovenular
anastomoses (PMA) was performed in a cohort of subjects undergoing CLND. Frequency
of lymphedema was compared among subjects undergoing and not-undergoing PMA during
CLND.
Results
We selected patients affected by melanoma of the trunk and with a minimum follow-up
of 3 years, identifying 23 patients who underwent PMA during CLND (PMA group) and
120 subjects who underwent CLND without PMA (control group). The frequency of lymphedema
was significantly lower in the PMA group than in the control group (4.3% vs. 24.2%,
p = 0.03). Patients of the PMA group and the control group showed similar 3-year recurrence-free
period (65.2% vs. 62.5%, log-rank test p = 0.88) and 3-year overall survival (73.9% vs. 72.5%, log-rank test p = 0.97) and frequency of nonsentinel-node metastases (26.7% vs. 30.4%, p = 0.71).
Conclusion
PMA appear to represent a useful and safe procedure in reducing the risk of lymphedema
in patients with melanoma undergoing CLND.
Keywords
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Article info
Publication history
Published online: February 08, 2019
Accepted:
January 18,
2019
Received:
July 1,
2018
Identification
Copyright
© 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
