O.D. Oloyede1, E.I. Papai1, M.C. Smaldone2, S.H. Greco2, S.S. Reddy2, A.S. Porpiglia2, J.M. Farma1,2 1Temple University, Medicine, Philadelpha, PA, USA 2Fox Chase Cancer Center, Surgical Oncology, Philadelphia, PA, USA
Introduction:
Surgical treatment of metastatic superficial inguinal lymph nodes is commonly used to treat various cancers, including penile, anal, and skin malignancies. Traditionally, open surgery has been used, resulting in postoperative soft tissue infections, fluid collections, and lymphedema. To reduce complications, minimally invasive inguinal lymph node dissection (MILND) has been developed. We aim to report our multidisciplinary experience and outcomes using MILND at a tertiary cancer center.
Methods:
Our prospective tumor registry and pathology database from January 2012 to December 2022, was queried for MILND patients. Data included patient demographics, comorbidities, cancer history, biopsy data, postoperative pathology, resection techniques, adjuvant therapy, and overall patient outcomes. All data was stored in REDCap after IRB approval.
Results:
28 patients met the inclusion criteria with 30 procedures, 7 of which were bilateral. The group consisted of 18 males and 10 females, predominantly Caucasian (22), with Hispanic/Latino (2), Black/African American (2), and other (2). The mean age was 63 years (35-81 years). Major pathologies were melanoma (12), penile cancer (11), anal cancer (2), cutaneous SCC (2), and Merkel cell carcinoma (1). Preoperative imaging included CT (11 patients) and PET/CT (14 patients). Indications for resection were palpable lymphadenopathy (22) and positive sentinel lymph node biopsy (6). The mean operative time for unilateral MILND (23 cases) was 160 minutes (range: 120-300 minutes) and for bilateral MILND (7 cases) 300 minutes (range: 240-420 minutes). The mean estimated blood loss was 37.1 mL (range: minimum-500 mL). A mean of 10 lymph nodes were harvested per procedure (range: 1-24), with a mean size of 2.6 cm (range: 0.8-4.6 cm). One drain was placed in 15 patients, 2 drains in 17 patients, and 3 drains per side in 2 patients. Mean hospital stay was 1.3 days (range: 1-9 days). Postoperative complications occurred in 43% (12/28) of patients and included lymphedema (11), seroma (4), wound infection (6), hematoma (2), motor neuropathy (2), wound necrosis (1), and skin breakdown (1). Clavien-Dindo scores were Grade I (7 patients), Grade II (5 patients), and Grade III (2 patients). The median time to drain removal was 5.7 weeks (range: 2 weeks-3 months). Disease recurrence occurred in 12 of 28 patients, 10 locally and 2 distally.
Conclusion:
MILND does not eliminate postoperative risks such as lymphedema, seroma, and wound infection. The majority of complications were mild to moderate. Compared to open procedures, MILND can be performed with minimal blood loss and the majority (70%) of patients can be discharged the next day. The wound complication rate (41%) was lower than historical open dissections. Further studies are needed to reduce complications while improving survival.