Sydney Medical School, The University of Sydney, Sydney, Australia.
Ann Surg Oncol. 2011 Sep;18(9):2521-8. doi: 10.1245/s10434-011-1755-7. Epub 2011 May 10.
Regional lymph node dissection (RLND) is currently the most effective therapy for metastatic melanoma in groin lymph nodes. With thorough surgery, RLND lymph node (LN) retrieval numbers have a predictable distribution. Whether patients have inguinal or ilioinguinal dissection varies between institutions. This study was designed to provide LN retrieval parameters for inguinal and ilioinguinal LN dissections, and secondarily, to analyze known predictors for survival outcomes, including LN ratio, i.e., involved/total number LN removed.
A prospective database was used to identify 189 patients who had 200 groin dissections between July 2002 and February 2008 to derive parameters of LN retrieval. A subgroup of 177 patients who had one RLND was assessed for predictors of survival outcome.
Inguinal dissection had median LN retrieval of 11 (interquartile range, 10-14); 8 LN or more were retrieved in 90% of cases, and 38% of cases had 10 LN or less. Ilioinguinal dissection had median LN retrieval of 21.5 (interquartile range, 17-25); 14 LN or more were retrieved in 90% of cases, and 0 cases had 10 LN or less. The strongest predictors of survival on multivariate analysis were LN ratio, macroscopic LN disease, and ulceration of the primary melanoma. Overall 39% of ilioinguinal dissections had positive pelvic LNs, but only 9.3% of those completed after positive sentinel node biopsy.
Thorough groin RLNDs have a predictable LN yield. LN ratio is the strongest predictor of outcome. Because pelvic LNs are frequently positive ilioinguinal dissection should be considered for all patients, especially those with macroscopic metastases to groin LNs.
区域淋巴结清扫术（RLND）是目前治疗腹股沟淋巴结转移黑色素瘤最有效的方法。通过彻底的手术，RLND 淋巴结（LN）的获取数量具有可预测的分布。各机构之间腹股沟或髂腹股沟清扫术的患者各不相同。本研究旨在为腹股沟和髂腹股沟 LN 清扫术提供 LN 检索参数，其次，分析已知的生存结果预测因素，包括 LN 比，即受累/切除的总 LN 数。
使用前瞻性数据库确定了 189 例患者，这些患者在 2002 年 7 月至 2008 年 2 月之间进行了 200 次腹股沟手术，以得出 LN 检索参数。对 177 例仅接受 1 次 RLND 的患者进行亚组分析，评估生存结果的预测因素。
腹股沟清扫术的 LN 中位数为 11（四分位距，10-14）；90%的病例中取出 8 个或更多 LN，38%的病例中取出 10 个或更少 LN。髂腹股沟清扫术的 LN 中位数为 21.5（四分位距，17-25）；90%的病例中取出 14 个或更多 LN，0 例中取出 10 个或更少 LN。多变量分析中最强的生存预测因素是 LN 比、宏观 LN 疾病和原发性黑色素瘤的溃疡。总体而言，39%的髂腹股沟清扫术有阳性盆腔 LN，但只有 9.3%的病例在阳性前哨淋巴结活检后完成。
彻底的腹股沟 RLND 具有可预测的 LN 产量。LN 比是结果的最强预测因素。由于盆腔 LN 经常为阳性，因此应考虑对所有患者进行髂腹股沟清扫术，尤其是那些腹股沟 LN 有宏观转移的患者。
