Picciotto F, Volpi E, Zaccagna A, Siatis D
Operative Unit of Surgical Dermatology, Institute for Cancer Research and Treatment, Strada Provinciale 142, Km 3.95, 10060 Candiolo, Italy.
Surg Endosc. 2003 Oct;17(10):1536-40. doi: 10.1007/s00464-002-9219-6. Epub 2003 Jul 21.
Current treatment for melanoma of the lower limb includes excision of the primary tumor with ilioinguinal lymphadenectomy in the case of lymph node metastases. The standard surgical approach includes sectioning of the inguinal ligament to gain access to the iliac nodes. More recently, some authors have reported that extraperitoneal laparoscopically assisted ilioinguinal lymphadenectomy for the treatment of malignant melanoma is feasible and less aggressive than standard open surgery. So far, no publications have described transperitoneal laparoscopic iliac lymphadenectomy (TPLND).
From November 2001 to June 2002, 13 patients with ilioinguinal node melanoma metastases underwent TPLND (stage IIIA in 1 case, IIIB in 5 cases, IIIC in 4 cases, and IV in 3 cases).
In all 13 cases, the TPLND and groin dissection was performed correctly. Operative time, intra- and postoperative complications, number of lymph nodes retrieved, immediate morbidity, hospital stay, and feasibility of TPLND were evaluated.
This study was conducted to evaluate the feasibility and the preliminary results of TPLND used to manage malignant melanoma of the lower limb. This approach has many advantages over the traditional procedure: less surgical trauma, no incision of the abdominal muscles or the inguinal ligament, and less postoperative pain. Moreover, as compared with extraperitoneal laparoscopically assisted ilioinguinal lymphoadenectomy, it provides an improved view of the operative area, dissection zone, and surrounding structures. Further research is needed to confirm these preliminary results regarding the potential applications of this method for treating malignant metastasis to the lower limb.
目前下肢黑色素瘤的治疗方法包括在发生淋巴结转移时切除原发肿瘤并进行髂腹股沟淋巴结清扫术。标准手术方法包括切断腹股沟韧带以显露髂淋巴结。最近，一些作者报道，腹膜外腹腔镜辅助髂腹股沟淋巴结清扫术治疗恶性黑色素瘤是可行的，且比标准开放手术侵袭性小。到目前为止，尚无关于经腹腹腔镜髂淋巴结清扫术（TPLND）的报道。
2001年11月至2002年6月，13例髂腹股沟淋巴结黑色素瘤转移患者接受了TPLND（1例为IIIA期，5例为IIIB期，4例为IIIC期，3例为IV期）。
13例患者均正确进行了TPLND及腹股沟清扫。评估了手术时间、术中和术后并发症、获取的淋巴结数量、即时发病率、住院时间以及TPLND的可行性。
本研究旨在评估TPLND用于治疗下肢恶性黑色素瘤的可行性和初步结果。该方法与传统手术相比有许多优点：手术创伤小，不切开腹部肌肉或腹股沟韧带，术后疼痛轻。此外，与腹膜外腹腔镜辅助髂腹股沟淋巴结清扫术相比，可以更好地观察手术区域、解剖区域及周围结构。需要进一步研究以证实该方法治疗下肢恶性转移瘤的潜在应用的这些初步结果。
