Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Oncology, University of Helsinki, Helsinki, Finland.
BJS Open. 2021 Nov 9;5(6). doi: 10.1093/bjsopen/zrab128.
Lower limb or trunk melanoma often presents with femoral and pelvic sentinel lymph nodes (SLNs). The benefits of harvesting pelvic lymph nodes remain controversial. In this retrospective study, the frequency and predictors of pelvic SLNs (PSLNs), and the impact of PSLNs on survival and staging was investigated.
Altogether 285 patients with cutaneous melanoma located in the lower limb or trunk underwent sentinel lymph node biopsy of the inguinal/iliac lymph node basin at Helsinki University Hospital from 2009-2013. Patient characteristics, detailed pathology reports and follow-up data were retrieved from hospital files. Subgroups of patients categorized by presence of PSLNs were compared for outcome parameters including progression-free survival, melanoma-specific survival and groin recurrence.
Superficial femoral/inguinal SLNs were present in all patients and 199 (69.8 per cent) also had PSLNs removed. Median number of SLNs per patient was five and median number of PSLNs was two. Sixty-three patients (22.1 per cent) had metastases in their SLNs and seven (2.5 per cent) had metastases in PSLNs. A single patient had metastases solely in PSLNs, while superficial SLNs remained negative. Harvesting PSLNs or the number of PSLNs retrieved had no impact on progression-free survival or overall survival. The removal of PSLNs did not affect the risk of postoperative seroma or lymphoedema. The only predictor of positive PSLNs was radioactivity count equal to or more than that of the hottest superficial SLNs.
Pelvic SLNs have minimal clinical impact on the outcome of melanoma patients especially in cases with negative superficial femoral/inguinal SLNs. Removal of PSLNs should be considered when they are the most radioactive nodes or equal to the hottest superficial femoral/inguinal SLNs in lymphoscintigraphy or during surgery.Preliminary results were presented in part at the International Sentinel Node Society Biennial Meeting, Tokyo, Japan, 11-13 October 2018.
下肢或躯干黑素瘤常表现为股部和骨盆前哨淋巴结（SLNs）。采集盆腔淋巴结的益处仍存在争议。在这项回顾性研究中，研究了盆腔前哨淋巴结（PSLNs）的频率和预测因素，以及 PSLNs 对生存和分期的影响。
2009 年至 2013 年，在赫尔辛基大学医院，共有 285 例位于下肢或躯干的皮肤黑素瘤患者接受了腹股沟/髂淋巴结 basin 的前哨淋巴结活检。从医院档案中检索了患者特征、详细的病理报告和随访数据。通过存在 PSLNs 将患者分为亚组，比较包括无进展生存期、黑素瘤特异性生存期和腹股沟复发在内的生存参数。
所有患者均存在股浅/腹股沟 SLNs，199 例（69.8%）还切除了 PSLNs。每位患者 SLNs 的中位数为 5 个，PSLNs 的中位数为 2 个。63 例（22.1%）患者 SLNs 中有转移，7 例（2.5%）患者 PSLNs 中有转移。仅有 1 例患者仅在 PSLNs 中有转移，而浅表 SLNs 仍为阴性。采集 PSLNs 或采集的 PSLNs 数量对无进展生存期或总生存期没有影响。PSLNs 阳性的唯一预测因素是放射性计数等于或大于最热的浅表 SLNs。
PSLNs 对黑素瘤患者的预后影响极小，尤其是在浅表股浅/腹股沟 SLNs 阴性的情况下。当 PSLNs 是放射性最强的淋巴结或在淋巴闪烁显像或手术中与最热的浅表股浅/腹股沟 SLNs 相等时，应考虑切除 PSLNs。初步结果部分在 2018 年 10 月 11 日至 13 日于日本东京举行的国际前哨淋巴结学会两年一次的会议上公布。
