Surgical Oncology, Tom Baker Cancer Center, Calgary, AB T2N 4N2, Canada.
Plastic and Reconstructive Surgery, Tom Baker Cancer Center, Calgary, AB T2N 4N2, Canada.
Curr Oncol. 2022 Aug 11;29(8):5655-5663. doi: 10.3390/curroncol29080446.
The present study was conducted to define the lymphedema rate at our institution in patients undergoing axillary (ALND) or inguinal (ILND) lymph node dissection (LND) for melanoma. It aimed to examine risk factors predisposing patients to a higher rate of lymphedema, highlighting which patients could be targeted for immediate lymphatic reconstruction (ILR).
A retrospective chart review was conducted between October 2015 and July 2020 to identify patients who had undergone ALND or ILND for melanoma. The main outcome measures were rates of transient and permanent lymphedema. Univariate and multivariate analyses were performed to assess the relationship between lymphedema rate and factors related to patient characteristics, surgical procedure, pathology findings, and adjuvant treatment.
Between October 2015 and July 2020, 66 patients underwent LND for melanoma: 34 patients underwent ALND and 32 patients underwent ILND. At a median follow-up of 29 months, 85.3% ( = 29) of patients having had an ALND did not experience lymphedema, versus 50.0% ( = 16) of ILND ( = 0.0019). The rates of permanent lymphedema for patients having undergone ALND and ILND were 11.8% ( = 4) and 37.5% ( = 12) respectively ( = 0.016, NS). The rate of transient lymphedema was 2.9% ( = 1) for ALND and 12.5% ( = 4) for ILND ( = 0.13, NS). On univariate analysis, the location of LND and wound infection were found to be significant factors for lymphedema. On multivariate analysis, only the location of LND remained a significant predictor, with the inguinal location predisposing to lymphedema.
This study highlights the high rate of lymphedema following ILND for melanoma and is a potential target for future patients to be considered for ILR.
本研究旨在确定我们机构在接受腋窝（ALND）或腹股沟（ILND）淋巴结清扫术（LND）治疗黑色素瘤的患者中淋巴水肿的发生率。其目的是检查导致患者淋巴水肿发生率更高的风险因素，突出哪些患者可以成为立即进行淋巴重建（ILR）的目标。
回顾性图表审查于 2015 年 10 月至 2020 年 7 月进行，以确定接受 ALND 或 ILND 治疗黑色素瘤的患者。主要观察指标为暂时性和永久性淋巴水肿的发生率。进行单变量和多变量分析，以评估淋巴水肿发生率与患者特征、手术过程、病理发现和辅助治疗相关因素之间的关系。
2015 年 10 月至 2020 年 7 月，66 例患者接受 LND 治疗黑色素瘤：34 例接受 ALND，32 例接受 ILND。中位随访 29 个月时，34 例行 ALND 的患者中有 85.3%（=29）未发生淋巴水肿，而 32 例行 ILND 的患者中有 50.0%（=16）发生淋巴水肿（=0.0019）。接受 ALND 和 ILND 的患者的永久性淋巴水肿发生率分别为 11.8%（=4）和 37.5%（=12）（=0.016，NS）。ALND 的暂时性淋巴水肿发生率为 2.9%（=1），ILND 为 12.5%（=4）（=0.13，NS）。单变量分析显示，LND 的位置和伤口感染是淋巴水肿的显著因素。多变量分析显示，只有 LND 的位置仍然是一个显著的预测因素，腹股沟位置易发生淋巴水肿。
本研究强调了黑色素瘤患者接受 ILND 后淋巴水肿的高发生率，这是未来患者考虑进行 ILR 的潜在目标。
