Minimizing Morbidity while Preserving Outcome after Inguinal Lymphadenectomy: Navigating between Scylla and Charybdis

Excerpt

Radical lymphadenectomy for microscopic or macroscopic metastases from cutaneous melanoma is associated with cure rates higher than many other widely performed radical procedures, such as radical pancreaticoduodenectomy or esophagectomy, that are associated with higher morbidity and mortality rates.1 Nonetheless, the morbidity associated with lymphadenectomy, especially inguinal or ilioinguinal lymphadenectomy, leads some patients to refuse—and even leads many surgical oncologists to discourage their patients from undergoing—this potentially curative procedure. However, the past few decades have seen substantial advances in our ability to identify the patients who are most appropriate for inguinal or ilioinguinal lymphadenectomy. These advances include the widespread adoption of sentinel node biopsy to identify microscopic nodal metastases, and the use of ultrasound and PET scanning to identify macroscopic nodal metastases before they become palpable or symptomatic. Whereas earlier detection in and of itself can lower operative morbidity, there has been much less attention paid to decreasing the morbidity of inguinal lymphadenectomy by altering the actual surgical technique. Fortunately for our patients, this has begun to change. In this issue of the Annals of Surgical Oncology, two articles describe efforts to decrease the morbidity of inguinal node dissection by performing the procedure through less invasive approaches than typically employed.2,3 Before we discuss these two papers, however, an examination of what is already known about the morbidity of inguinal node dissection is in order. …