Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy.
Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, 11, Piazza Giulio Cesare, Bari 70124, Italy; Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02131, United States.
J Plast Reconstr Aesthet Surg. 2019 Apr;72(4):642-648. doi: 10.1016/j.bjps.2019.01.023. Epub 2019 Feb 10.
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.
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.
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).
PMA appear to represent a useful and safe procedure in reducing the risk of lymphedema in patients with melanoma undergoing CLND.
前哨淋巴结活检（SLNB）是中厚型黑色素瘤分期和治疗中不可或缺的手术程序。尽管最近的研究表明完全淋巴结清扫术（CLND）不能提高 3 年特异性生存率，但它在延长无病间期和控制局部疾病方面的作用仍然得到证实。CLND 最常见的并发症是淋巴水肿，多达 20%接受 CLND 的患者可能会发生这种并发症。预防性使用淋巴管静脉显微吻合术可以避免这种并发症。
我们进行了一项单机构回顾性病例对照研究。所有 SLNB 阳性的患者均行 CLND；在一组接受 CLND 的患者中，行预防性淋巴管静脉吻合术（PMA）。比较 CLND 时行 PMA 与不行 PMA 的患者淋巴水肿的发生率。
我们选择了患有躯干黑色素瘤且随访时间至少 3 年的患者，共纳入 23 例在 CLND 时行 PMA 的患者（PMA 组）和 120 例在 CLND 时不行 PMA 的患者（对照组）。PMA 组淋巴水肿的发生率明显低于对照组（4.3%比 24.2%，p=0.03）。PMA 组和对照组患者的 3 年无复发生存期（65.2%比 62.5%，log-rank 检验 p=0.88）和 3 年总生存率（73.9%比 72.5%，log-rank 检验 p=0.97）及非前哨淋巴结转移率（26.7%比 30.4%，p=0.71）相似。
PMA 似乎是一种有用且安全的方法，可以降低接受 CLND 的黑色素瘤患者发生淋巴水肿的风险。
