A pilot study reporting outcomes for melanoma patients of a minimal access ilio-inguinal dissection technique based on two incisions.

Background: A modified procedure for ilio-inguinal regional lymph node dissection (I-I RLND) involving 2 small skin incisions was evaluated with the aim of assessing surgical and oncological noninferiority compared with the traditional single, longitudinal incision I-I RLND.
Materials and Methods: A total of 20 melanoma patients with positive groin lymph nodes who had traditional I-I RLND were compared with 20 patients who had a minimal access I-I RLND using 2 small surgical access incisions of 3-6 cm in length--one sited below and one above the inguinal ligament. Clinical, staging features, number of lymph nodes retrieved, length of hospital stay, time drains remained in situ, morbidity (wound infections, dehiscence, hematoma, seroma, and lymphedema), and disease free survival were compared.
Results: Patients in the groups were comparable with the exception that the minimal access I-I RLND group had a higher rate of AJCC stage N3 disease (60% vs 20%; P = .03) and more cases with extranodal spread (45% vs 15%; P = .041). After a median follow-up of 5 months (range 1-8) for the minimal access group and median 13 months (range 1-30) for the standard group there were no differences in disease-free survival (P = .13). Retrieved lymph node counts were similar (P = .34) including for the inguinal and pelvic components of the operations separately. No significant differences in wound complications or rates of early lymphedema were observed.
Conclusions: At early follow-up, minimal access I-I RLND is feasible and noninferior to single longitudinal incision I-I RLND in regard to surgical morbidity and oncological outcome. Further evaluation is progressing.