Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era
<i>Background and Objectives</i>: Current guidelines have limited the performance of complete lymph node dissection (CLND) for patients with clinically detectable lymphatic metastases. Despite the limitations of this surgical procedure, secondary lymphedema (SL) is an unsolved problem th...
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| Format: | Article |
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MDPI AG
2022-01-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/1/117 |
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| author | Eleonora Nacchiero Michele Maruccia Fabio Robusto Rossella Elia Alessio De Cosmo Giuseppe Giudice |
| author_facet | Eleonora Nacchiero Michele Maruccia Fabio Robusto Rossella Elia Alessio De Cosmo Giuseppe Giudice |
| author_sort | Eleonora Nacchiero |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Current guidelines have limited the performance of complete lymph node dissection (CLND) for patients with clinically detectable lymphatic metastases. Despite the limitations of this surgical procedure, secondary lymphedema (SL) is an unsolved problem that affects approximately 20% of patients undergoing CLND. Preventive lymphatic–venous micro-anastomoses (PMLVA) has already demonstrated its efficacy in the prevention of SL in melanoma patients with a positive sentinel lymph node biopsy (SLNB), but the efficacy of this procedure is not demonstrated in patients with clinically detectable lymphatic metastases. <i>Materials and Methods</i>: This retrospective cohort study, was performed in two observation periods. Until March 2018, CLND was proposed to all subjects with positive-SLNB andPMLVA was performed in a subgroup of patients with risk factors for SL (Group 1). From April 2018, according to the modification of melanoma guidelines, all patients with detectable metastatic lymph nodes underwent PMLVA during CLND (Group 2). The frequency of lymphedema in subjects undergoing PMLVA was compared with the control group. <i>Results</i>: Database evaluation revealed 172 patients with melanoma of the trunk with follow-up information for at least 6 mounts. Twenty-three patients underwent PMLVA during CLND until March 2018, 29 from April 2018, and 120 subjects underwent CLND without any preventive surgery (control Group). The frequency of SL was significantly lower in both Group 1 (4.3% vs. 24.2%, <i>p</i> = 0.03) and Group 2 (3.5%, <i>p</i> = 0.01). Patients undergoing PMLVA showed a similar recurrence-free periods and overall survival when compared to the control group. <i>Conclusions</i>: PMLVA significantly reduces the frequency of SL both in immediate and delayed CLND. This procedure is safe and does not lead to an increase in length of hospitalization. |
| first_indexed | 2024-03-10T00:59:47Z |
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| language | English |
| last_indexed | 2024-03-10T00:59:47Z |
| publishDate | 2022-01-01 |
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| series | Medicina |
| spelling | doaj.art-8671f190ed3d47d99350256b21247d862023-11-23T14:37:13ZengMDPI AGMedicina1010-660X1648-91442022-01-0158111710.3390/medicina58010117Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational EraEleonora Nacchiero0Michele Maruccia1Fabio Robusto2Rossella Elia3Alessio De Cosmo4Giuseppe Giudice5Department of Plastic Reconstructive and Aesthetic Surgery, Università degli Studi di Bari, 70121 Bari, ItalyDepartment of Plastic Reconstructive and Aesthetic Surgery, Università degli Studi di Bari, 70121 Bari, ItalyMedonline-Statte, Asl Ta, 74010 Statte, TA, ItalyDepartment of Plastic Reconstructive and Aesthetic Surgery, Università degli Studi di Bari, 70121 Bari, ItalyDepartment of Plastic Reconstructive and Aesthetic Surgery, Università degli Studi di Bari, 70121 Bari, ItalyDepartment of Plastic Reconstructive and Aesthetic Surgery, Università degli Studi di Bari, 70121 Bari, Italy<i>Background and Objectives</i>: Current guidelines have limited the performance of complete lymph node dissection (CLND) for patients with clinically detectable lymphatic metastases. Despite the limitations of this surgical procedure, secondary lymphedema (SL) is an unsolved problem that affects approximately 20% of patients undergoing CLND. Preventive lymphatic–venous micro-anastomoses (PMLVA) has already demonstrated its efficacy in the prevention of SL in melanoma patients with a positive sentinel lymph node biopsy (SLNB), but the efficacy of this procedure is not demonstrated in patients with clinically detectable lymphatic metastases. <i>Materials and Methods</i>: This retrospective cohort study, was performed in two observation periods. Until March 2018, CLND was proposed to all subjects with positive-SLNB andPMLVA was performed in a subgroup of patients with risk factors for SL (Group 1). From April 2018, according to the modification of melanoma guidelines, all patients with detectable metastatic lymph nodes underwent PMLVA during CLND (Group 2). The frequency of lymphedema in subjects undergoing PMLVA was compared with the control group. <i>Results</i>: Database evaluation revealed 172 patients with melanoma of the trunk with follow-up information for at least 6 mounts. Twenty-three patients underwent PMLVA during CLND until March 2018, 29 from April 2018, and 120 subjects underwent CLND without any preventive surgery (control Group). The frequency of SL was significantly lower in both Group 1 (4.3% vs. 24.2%, <i>p</i> = 0.03) and Group 2 (3.5%, <i>p</i> = 0.01). Patients undergoing PMLVA showed a similar recurrence-free periods and overall survival when compared to the control group. <i>Conclusions</i>: PMLVA significantly reduces the frequency of SL both in immediate and delayed CLND. This procedure is safe and does not lead to an increase in length of hospitalization.https://www.mdpi.com/1648-9144/58/1/117secondary lymphedemamultiple lymphatic venous anastomosismelanomacomplete lymph node dissectionobservational era |
| spellingShingle | Eleonora Nacchiero Michele Maruccia Fabio Robusto Rossella Elia Alessio De Cosmo Giuseppe Giudice Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era Medicina secondary lymphedema multiple lymphatic venous anastomosis melanoma complete lymph node dissection observational era |
| title | Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era |
| title_full | Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era |
| title_fullStr | Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era |
| title_full_unstemmed | Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era |
| title_short | Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era |
| title_sort | prevention of secondary lymphedema after complete lymph node dissection in melanoma patients the role of preventive multiple lymphatic venous anastomosis in observational era |
| topic | secondary lymphedema multiple lymphatic venous anastomosis melanoma complete lymph node dissection observational era |
| url | https://www.mdpi.com/1648-9144/58/1/117 |
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